腹腔鏡與傳統(tǒng)開腹胰體尾切除術(shù)臨床療效對(duì)比分析.pdf

1、Ⅰ腹腔鏡與傳統(tǒng)開腹胰體尾切除術(shù)臨床療效對(duì)比分析 腹腔鏡與傳統(tǒng)開腹胰體尾切除術(shù)臨床療效對(duì)比分析摘要 摘要目的 目的：目前，對(duì)于胰腺體尾部疾病尤其是胰腺導(dǎo)管腺癌等惡性腫瘤行手術(shù)治療是胰腺外科的主要方法。 其中應(yīng)用最廣、 療效最確切的是傳統(tǒng)開腹胰體尾部切除術(shù) （opendistal pancreatectomy,0DP）。但隨著近20年來腹腔鏡技術(shù)的蓬勃發(fā)展，腹腔鏡胰腺微創(chuàng)技術(shù)正越來越多應(yīng)用于治療胰腺體尾部良性、惡性腫瘤。對(duì)于腹腔鏡下胰體尾切

2、除術(shù)（laparoscopic distal pancreatectomy, LDP )手術(shù)可行性、安全性及臨床療效的爭(zhēng)論與研究也逐漸增多。本研究通過比較分析LDP組與ODP患者術(shù)前、術(shù)中、術(shù)后的相關(guān)臨床病理資料，比較兩種手術(shù)方式對(duì)于治療胰體尾部腫瘤臨床療效的差異，進(jìn)而評(píng)價(jià)LDP的臨床應(yīng)用價(jià)值。方法 方法：收集青島大學(xué)附屬醫(yī)院肝膽外科、普外科、器官移植中心自2011年1月至2016年6月所行232例胰體尾部切除術(shù)患者的臨床資料，其中LD

3、P患者67例，ODP患者165例。在最初所選行LDP的患者中，有11例行腹腔鏡中轉(zhuǎn)開腹手術(shù)（中轉(zhuǎn)率12.5％），按最終治療手段區(qū)分將其納入ODP組。去除29例聯(lián)合臟器切除患者（術(shù)中聯(lián)合其他臟器切除，包括胃、結(jié)腸、腎、肝臟等），共有203例患者納入統(tǒng)計(jì)分析。最終LDP患者65例，ODP患者138例。所有患者術(shù)前、術(shù)中、術(shù)后與研究相關(guān)的臨床指標(biāo)無缺失。比較分析兩組患者術(shù)前臨床相關(guān)指標(biāo)，為減少兩組患者疾病惡性率不同所致偏倚，將兩組手術(shù)患者按良

4、、惡性疾病進(jìn)行分組研究，分別比較兩組患者良惡性疾病的手術(shù)相關(guān)指標(biāo)及其術(shù)后恢復(fù)情況并應(yīng)用SPSS 23.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析、確定兩者有無統(tǒng)計(jì)學(xué)差異，進(jìn)而研究?jī)煞N手術(shù)方式的臨床療效。結(jié)果： 結(jié)果：LDP組與ODP組患者術(shù)前基本資料如年齡、性別、BMI、術(shù)前糖尿病史、上腹手術(shù)史、術(shù)前白蛋白、術(shù)前血紅蛋白等相關(guān)指標(biāo)無顯著差異（P＞0.05）。臨床病理結(jié)果研究顯示ODP組患者疾病惡性率明顯高于LDP組患者（59.4% VS 32.3%，P＜0.

5、05）、腫瘤體積LDP組患者大于ODP組患者（P＜0.05）。分別對(duì)兩組患者中良、惡性疾病相關(guān)指標(biāo)對(duì)比分析可見：對(duì)于胰腺良性疾病及惡性疾病，相較于ODP組，LDP組患者手術(shù)時(shí)間長(zhǎng)、手術(shù)費(fèi)用高（P＜0.05），術(shù)中有無輸血兩者無差異（P＞0.05）。對(duì)于良性腫瘤，LDP術(shù)中出血量明顯少于ODP（P＜0.05）：對(duì)于胰腺惡性腫瘤，LDP術(shù)中出血量與ODP組無差異（P＞0.05）。但是，LDP組患者術(shù)中保脾率高（P＜0.05），術(shù)后住院時(shí)間、

6、術(shù)后進(jìn)食時(shí)間、引流管拔除時(shí)間短（P＜0.05）。術(shù)后出血、切口感染、胰瘺等并發(fā)癥發(fā)生率以及圍手術(shù)期死亡率等與ODP組患者無差異（P＞0.05）。結(jié)論 結(jié)論：LDP并未增加手術(shù)患者術(shù)后并發(fā)癥發(fā)生率，淋巴結(jié)清掃率、RO切除率與ODPⅢA Comparative Analysis of the Effect of Laparoscopic versus traditionalOpen Distal PancreatectomyAbstract

7、Object: At present, surgical treatment is the main method of the diseases of the body andtail of pancreas especially malignant ones like ductal adenocarcinoma. Traditional opendistal pancreatectomy (ODP) is the most wide

8、ly used and has the most exact curativeeffect. As a result of technological advances during the past two decades, laparoscopicpancreatic minimally invasive techniques are increasingly used in the treatment ofpancreatic b

9、ody and tail of benign or malignant tumors. For laparoscopic distalpancreatectomy (LDP), the feasibility of the operation, debate and study of the clinicalefficacy and safety are gradually increased. Through a comparativ

10、e analysis of thepreoperative, intraoperative and postoperative clinical data of LDP group and ODPpatients, the study aims to analyse the difference between the two surgical methods forclinical tumor treatment of pancrea

11、tic body and tail, and to evaluate the clinical value ofLDP.Methods: Collecting the clinical index of 232 patients who underwent distalpancreatectomy in Affiliated Hospital of Qingdao University from Jan. 2011 to Jun. 20

12、16.All the operations are performed in the department of Hepatobiliary Surgery, Departmentof General Surgery, Organ Transplantation Center. There are 67 patients who underwentLDP and 165 cases of ODP patients. In the fir

13、st row selected LDP patients, 11 casestransfer to ODP during operation (transfer rate is 12.5%), according to the distinction offinal treatment, these cases are incorporated into the ODP group. Removing 29 cases whounder

14、went combined organ resection (surgery combined with other organ resection,including stomach, colon, kidney, liver), finally, 203 patients were included in thestatistical analysis. Totally, there are 65 cases of LDP pati

15、ents, 138 cases of ODP patients.No lack of related preoperative, intraoperative, postoperative clinical indicators.Comparing the preoperative clinical index of these patients and then divide these patientsinto two groups

16、 according to benign or malignant diseases in order to reduce the biascaused by the different rate of malignant disease of the two groups of patients. Comparethe intraoperative characteristics and post-operative recovery