摘要
目的评估腹腔镜胰十二指肠切除术(LPD)的安全性和疗效。方法回顾性分析湖南省人民医院2015年1月至2019年12月989例行胰十二指肠切除术患者临床资料,其中LPD组349例,开腹胰十二指肠切除术(OPD)组640例。使用倾向性得分匹配对两组患者基线资料进行1∶1匹配,比较匹配后两组患者的手术时间、术中出血量、术后住院时间、胆漏、胰瘘、伤口感染等术后并发症等指标。结果倾向性得分匹配后LPD组与OPD组每组患者345例,两组患者在术后死亡人数、再次手术、术中输血、胰瘘、胆漏、腹腔出血、腹腔脓肿、严重并发症、肺部并发症、淋巴结清扫数目、R0切除和总体生存率方面,差异均无统计学意义(均P>0.05)。LPD组手术时间(478.2±91.3)min较OPD组(410.8±62.0)min长,差异具有统计学意义(P<0.05);但LPD组术后住院时间(10.8±4.3)d、术中出血量(322.0±362.6)ml、伤口感染发生率1.2%(4/345)均优于OPD组的术后住院时间(12.5±7.9)d、术中出血量(478.8±570.2)ml、伤口感染发生率5.8%(20/345),差异有统计学意义(均P<0.05)。结论LPD安全可行,不会增加术后并发症发生率,且可取得与OPD相似的疗效。
Objective To compare the safety and efficacy of laparoscopic versus open pancreaticoduodenectomy.Methods The clinical data of 989 patients who underwent pancreaticoduodenectomy at Hunan People's Hospital from January 2015 to December 2019 were analyzed retrospectively.There were 349 patients in the laparoscopic pancreaticoduodenectomy(LPD)group and 640 patients in the open pancreaticoduodenectomy(OPD)group.Propensity score matching(PSM)was used to match the baseline data of the two groups at a 1:1 ratio.Data including operation time,intraoperative bleeding,postoperative hospital stay,bile leakage,pancreatic fistula and wound infection were compared between the two groups.Results After PSM,there were 345 patients in each of the 2 groups.When the LPD group was compared with the OPD group,there were no significant differences in postoperative mortality,reoperation,intraoperative blood transfusion,pancreatic fistula,bile leakage,abdominal hemorrhage,abdominal abscess,severe complications,and pulmonary complication rates.The number of lymph node dissected,R0 resection and overall survival rates between the two groups were also not significantly different(P>0.05).However,the operation time of the LPD group(478.2±91.3)min was significantly longer than that of the OPD group(410.8±62.0)min(P<0.05).On the other hand,the postoperative hospitalization time(10.8±4.3)d,intraoperative bleeding(322.0±362.6)ml,wound infection rate 1.2%(4/345)in the LPD group were significantly better than those in the OPD group[postoperative hospitalization time(12.5±7.9)d,intraoperative bleeding(478.8±570.2)ml,and wound infection rate 5.8%(20/345)](P<0.05).Conclusion LPD was safe and feasible,and it achieved similar curative effect as OPD.
作者
吴子龙
周芬
李林欢
陈顺
王方明
王俊
吕品
梁刚
田秉璋
周力学
欧晔
Wu Zilong;Zhou Fen;Li Linhuan;Chen Shun;Wang Fangming;Wang Jun;Lyu Pin;Liang Gang;Tian Bingzhang;Zhou Lixue;Ou Ye(Department of Hepatobiliary Surgery,First Affiliated Hospital of Hunan Normal University,Hunan Provincial People’s Hospital,Changsha 410005,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2021年第7期520-524,共5页
Chinese Journal of Hepatobiliary Surgery
