腹腔鏡與傳統(tǒng)開(kāi)腹胰體尾切除術(shù)臨床療效對(duì)比分析
發(fā)布時(shí)間：2018-08-04 21:53
【摘要】：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(kāi)腹胰體尾部切除術(shù)(open distal pancreatectomy,0DP)。但隨著近20年來(lái)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(lái)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(guò)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: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(kāi)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(wú)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、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(wú)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: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(wú)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(duì)兩組患者中良、惡性疾病相關(guān)指標(biāo)對(duì)比分析可見(jiàn):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(P0.05),術(shù)中有無(wú)輸血兩者無(wú)差異(P0.05)。對(duì)于良性腫瘤,LDP術(shù)中出血量明顯少于ODP(P0.05):對(duì)于胰腺惡性腫瘤,LDP術(shù)中出血量與ODP組無(wú)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(shí)間、術(shù)后進(jìn)食時(shí)間、引流管拔除時(shí)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(wú)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(fù)快。LDP對(duì)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(yù)后也優(yōu)于ODP。但其長(zhǎng)期療效仍待進(jìn)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(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.5
本文編號(hào)：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(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.5
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