腹腔鏡與傳統(tǒng)開腹胰體尾切除術(shù)臨床療效對比分析
發(fā)布時間：2018-08-04 21:53
【摘要】：目的:目前,對于胰腺體尾部疾病尤其是胰腺導管腺癌等惡性腫瘤行手術(shù)治療是胰腺外科的主要方法。其中應用最廣、療效最確切的是傳統(tǒng)開腹胰體尾部切除術(shù)(open distal 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)正越來越多應用于治療胰腺體尾部良性、惡性腫瘤。對于腹腔鏡下胰體尾切除術(shù)(laparoscopic distal pancreatectomy,LDP)手術(shù)可行性、安全性及臨床療效的爭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)后的相關臨床病理資料,比較兩種手術(shù)方式對于治療胰體尾部腫瘤臨床療效的差異,進而評價LDP的臨床應用價值。方法:收集青島大學附屬醫(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LDP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)后與研究相關的臨床指標無缺失。比較分析兩組患者術(shù)前臨床相關指標,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、惡性疾病進行分組研究,分別比較兩組患者良惡性疾病的手術(shù)相關指標及其術(shù)后恢復情況并應用SPSS 23.0軟件進行統(tǒng)計學分析、確定兩者有無統(tǒng)計學差異,進而研究兩種手術(shù)方式的臨床療效。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)前血紅蛋白等相關指標無顯著差異(P0.05)。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%,P0.05)、腫瘤體積LDP組患者大于ODP組患者(P0.05)。分別對兩組患者中良、惡性疾病相關指標對比分析可見:對于胰腺良性疾病及惡性疾病,相較于ODP組,LDP組患者手術(shù)時間長、手術(shù)費用高(P0.05),術(shù)中有無輸血兩者無差異(P0.05)。對于良性腫瘤,LDP術(shù)中出血量明顯少于ODP(P0.05):對于胰腺惡性腫瘤,LDP術(shù)中出血量與ODP組無差異(P0.05)。但是,LDP組患者術(shù)中保脾率高(P0.05),術(shù)后住院時間、術(shù)后進食時間、引流管拔除時間短(P0.05)。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(P0.05)。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ODP效果相同,但LDP患者術(shù)后恢復快。LDP對于胰體尾部腫瘤是一種安全、有效的手術(shù)方式。LDP臨床療效優(yōu)于ODP、短期預后也優(yōu)于ODP。但其長期療效仍待進一步研究。
[Abstract]:Objective: at present, surgical treatment of pancreatic body and tail diseases, especially pancreatic ductal adenocarcinoma, is the main method of pancreatic surgery. Among them, (open distal pancreatectomy0DP was the most widely used and the most effective one was traditional open pancreatectomy (open distal pancreatectomy0DP). However, with the rapid development of laparoscopic technique in recent 20 years, laparoscopic minimally invasive pancreatic technique has been applied more and more in the treatment of benign and malignant tumors of pancreatic body and tail. The feasibility, safety and clinical efficacy of laparoscopic resection of the body and tail of pancreas (laparoscopic distal pancreatectomytomy) were also increased. This study compared the clinical and pathological data between LDP group and ODP patients before, during and after operation, and compared the difference between the two surgical methods in treating pancreatic body and tail tumor, and then evaluated the clinical application value of LDP. Methods: from January 2011 to June 2016, 232 patients underwent hepatobiliary surgery, general surgery and organ transplantation in the affiliated Hospital of Qingdao University, including 67 patients with LDP and 165 patients with ODP. Among the patients who were initially selected for LDP, 11 patients underwent laparoscopic conversion to open surgery (conversion rate was 12.5%), which was included in the ODP group according to the final treatment. A total of 203 patients were included in the statistical analysis after removal of 29 cases of combined organ resection (intraoperative resection of other organs, including stomach, colon, kidney, liver, etc.). Finally, there were 65 patients with LDP and 138 patients with ODP. In all patients, there was no absence of clinical parameters related to the study before, during and after operation. In order to reduce the bias caused by the difference in the malignant rate of the two groups of patients, the two groups of patients were divided into two groups according to benign and malignant diseases. The related indexes and postoperative recovery of benign and malignant diseases in the two groups were compared, and the statistical analysis was carried out by using SPSS 23. 0 software to determine whether there was statistical difference between the two groups, and then to study the clinical effect of the two kinds of operation methods. Results there was no significant difference in preoperative basic data such as age, sex, history of diabetes mellitus, history of upper abdominal surgery, preoperative albumin and preoperative hemoglobin between the two groups (P0.05). The clinicopathological results showed that the malignant rate of ODP group was significantly higher than that of LDP group (59.4%VS 32.3g / P0.05), and the tumor volume of LDP group was higher than that of ODP group (P0.05). For benign and malignant pancreatic diseases, compared with ODP group, the operation time was longer, the operation cost was high (P0.05), and there was no difference between the two groups (P0.05). The amount of intraoperative bleeding for benign tumors was significantly less than that for ODP (P0.05); for pancreatic malignant tumors, there was no difference between LDP and ODP (P0.05). But in LDP group, the rate of spleen preservation during operation was high (P0.05), postoperative hospitalization time, postoperative feeding time and extubation time of drainage tube were short (P0.05). The incidence of postoperative bleeding, incision infection, pancreatic fistula and perioperative mortality were not significantly different from those in ODP group (P0.05). Conclusion the postoperative complications were not increased in patients with LDP, and the lymph node dissection rate and RO resection rate were the same as those of ODP, but the recovery of LDP patients was safe for tumors of the body and tail of pancreas. The clinical efficacy of LDP was better than that of ODP, and the short term prognosis was better than that of ODP. But its long-term curative effect still needs further research.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.5
本文編號：2165282
[Abstract]:Objective: at present, surgical treatment of pancreatic body and tail diseases, especially pancreatic ductal adenocarcinoma, is the main method of pancreatic surgery. Among them, (open distal pancreatectomy0DP was the most widely used and the most effective one was traditional open pancreatectomy (open distal pancreatectomy0DP). However, with the rapid development of laparoscopic technique in recent 20 years, laparoscopic minimally invasive pancreatic technique has been applied more and more in the treatment of benign and malignant tumors of pancreatic body and tail. The feasibility, safety and clinical efficacy of laparoscopic resection of the body and tail of pancreas (laparoscopic distal pancreatectomytomy) were also increased. This study compared the clinical and pathological data between LDP group and ODP patients before, during and after operation, and compared the difference between the two surgical methods in treating pancreatic body and tail tumor, and then evaluated the clinical application value of LDP. Methods: from January 2011 to June 2016, 232 patients underwent hepatobiliary surgery, general surgery and organ transplantation in the affiliated Hospital of Qingdao University, including 67 patients with LDP and 165 patients with ODP. Among the patients who were initially selected for LDP, 11 patients underwent laparoscopic conversion to open surgery (conversion rate was 12.5%), which was included in the ODP group according to the final treatment. A total of 203 patients were included in the statistical analysis after removal of 29 cases of combined organ resection (intraoperative resection of other organs, including stomach, colon, kidney, liver, etc.). Finally, there were 65 patients with LDP and 138 patients with ODP. In all patients, there was no absence of clinical parameters related to the study before, during and after operation. In order to reduce the bias caused by the difference in the malignant rate of the two groups of patients, the two groups of patients were divided into two groups according to benign and malignant diseases. The related indexes and postoperative recovery of benign and malignant diseases in the two groups were compared, and the statistical analysis was carried out by using SPSS 23. 0 software to determine whether there was statistical difference between the two groups, and then to study the clinical effect of the two kinds of operation methods. Results there was no significant difference in preoperative basic data such as age, sex, history of diabetes mellitus, history of upper abdominal surgery, preoperative albumin and preoperative hemoglobin between the two groups (P0.05). The clinicopathological results showed that the malignant rate of ODP group was significantly higher than that of LDP group (59.4%VS 32.3g / P0.05), and the tumor volume of LDP group was higher than that of ODP group (P0.05). For benign and malignant pancreatic diseases, compared with ODP group, the operation time was longer, the operation cost was high (P0.05), and there was no difference between the two groups (P0.05). The amount of intraoperative bleeding for benign tumors was significantly less than that for ODP (P0.05); for pancreatic malignant tumors, there was no difference between LDP and ODP (P0.05). But in LDP group, the rate of spleen preservation during operation was high (P0.05), postoperative hospitalization time, postoperative feeding time and extubation time of drainage tube were short (P0.05). The incidence of postoperative bleeding, incision infection, pancreatic fistula and perioperative mortality were not significantly different from those in ODP group (P0.05). Conclusion the postoperative complications were not increased in patients with LDP, and the lymph node dissection rate and RO resection rate were the same as those of ODP, but the recovery of LDP patients was safe for tumors of the body and tail of pancreas. The clinical efficacy of LDP was better than that of ODP, and the short term prognosis was better than that of ODP. But its long-term curative effect still needs further research.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.5
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