Xu K, Su J J, Su M, Yan L, Feng J, Xin X L, Chen Y L
Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Zhong Liu Za Zhi. 2017 Oct 23;39(10):783-786. doi: 10.3760/cma.j.issn.0253-3766.2017.10.012.
To compare and evaluate the curative effect of laparoscopic distal pancreatectomy(LDP) and traditional open distal pancreatectomy(ODP) in pancreatic ductal adenocarcinoma. The clinical data of 15 patients treated by LDP and 87 contemporaneous cases treated by ODP from January 2010 to November 2015 was collected, and the curative effect and prognosis of these patients were retrospectively analyzed. The operation time of LDP group was (286.5±48.1) min, significantly longer than that of OPD group(226.6±56.8) min (<0.05). The operative hemorrhage, postoperative exhaust time, recovery eating time, the whole and postoperative hospitalization time of LDP group were (188.7±108.9) ml, (2.2±1.3) d, (2.9±1.1) d, (13.2±10.4) d and (9.3±8.1) d, respectively, dramatically shorter than those of ODP group (625.2±982.1) ml, (4.3±1.7) d, (5.2±1.8) d, (20.7±8.7) d and (14.9±7.8) d, respectively (all of <0.05). There were no intraoperative blood transfusion case in LDP group, however, 13 patients in ODP group received intraoperative blood transfusion, without significant difference (=0.207). Alternatively, 6 cases occurred pancreatic fistula in LDP group, among them, 5 cases were grade A and 1 case was grade B; In ODP group, 17 cases occurred pancreatic fistula, among them 13 cases were grade A, 1 case was grade B and 3 cases were grade C, without significant differences (=0.130). There were 2 cases of delayed gastric empty, 1 case of pulmonary infection in LDP group. In ODP group, there were 5 cases of postoperative delayed gastric empty, 3 cases of pulmonary infection and 6 cases of intra-abdominal infection, without significant differences (>0.05). In both LDP group and ODP group, none occurred percutaneous drainage, re-admissions, second operation or perioperative death. Compared to ODP, LDP is much safer and more steady in perioperative periodand operation. Patients of pancreatic ductal adenocarcinoma received LDP can acquire more benefit and recovery sooner, and LDP is a safe and effective operative method.
比较和评估腹腔镜胰体尾切除术(LDP)与传统开放性胰体尾切除术(ODP)治疗胰腺导管腺癌的疗效。收集2010年1月至2015年11月期间接受LDP治疗的15例患者及同期接受ODP治疗的87例患者的临床资料,对这些患者的疗效及预后进行回顾性分析。LDP组手术时间为(286.5±48.1)分钟,显著长于ODP组(226.6±56.8)分钟(<0.05)。LDP组术中出血量、术后排气时间、恢复进食时间、总住院时间及术后住院时间分别为(188.7±108.9)ml、(2.2±1.3)天、(2.9±1.1)天、(13.2±10.4)天和(9.3±8.1)天,均显著短于ODP组的(625.2±982.1)ml、(4.3±1.7)天、(5.2±1.8)天、(20.7±8.7)天和(14.9±7.8)天(均<0.05)。LDP组无术中输血病例,而ODP组有13例患者术中输血,差异无统计学意义(=0.207)。另外,LDP组发生胰瘘6例,其中A级5例,B级1例;ODP组发生胰瘘17例,其中A级13例,B级1例,C级3例,差异无统计学意义(=0.130)。LDP组发生2例胃排空延迟,1例肺部感染。ODP组发生术后胃排空延迟5例,肺部感染3例,腹腔内感染6例,差异无统计学意义(>0.05)。LDP组和ODP组均未发生经皮引流、再次入院、二次手术或围手术期死亡。与ODP相比,LDP在围手术期和手术过程中更安全、更稳定。接受LDP治疗的胰腺导管腺癌患者获益更多,恢复更快,LDP是一种安全有效的手术方法。