LPD与OPD的短期疗效比较分析

Comparative Analysis of Curative Effect between LPD and OPD

摘要: 目的：比较腹腔镜胰十二指肠切除术(LPD)与开腹胰十二指肠切除术(OPD)的临床疗效。方法：回顾性收集新疆医科大学第一附属医院2015年1月至2021年1月期间完成的33例腹腔镜胰十二指肠切除术患者及33例开腹胰十二指肠切除术患者资料。比较两组手术时间，术中出血量，术中输血情况，术后排气时间，术后首次下床时间，术后住院天数，带管时间，住院总费用及术后并发症发生情况。结果：两组手术出血量，住院总费用无统计学差异(P > 0.05)，手术时间LPD组大于OPD组(P < 0.05)，术后平均排气时间，术后首次下床时间，术后住院天数，带管时间LPD组小于OPD组(P < 0.05)。其中LPD组术后发生胰瘘5例，胆瘘2例，腹腔感染8例，胃瘫综合征1例，腹腔内出血2例，二次手术3例，围手术期死亡2例；OPD组术后发生胰瘘4例，胆瘘1例，腹腔感染6例，胃瘫综合征5例，腹腔内出血3例，二次手术2例，围手术期死亡1例，其余无明显严重并发症发生；两组术后总并发症发生率无明显统计学差异(P > 0.05)。结论：开腹和腹腔镜胰十二指肠切除术均安全有效，腹腔镜胰十二指肠切除术在不增加并发症的情况下，术后恢复优于开腹腹腔镜胰十二指肠切除术。

Abstract: Objective: To compare the clinical effects of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD). Methods: The data of 33 patients with laparoscopic pancreaticoduodenectomy and 33 patients with open pancreaticoduodenectomy completed in the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2021 were collected retrospectively. The operation time, intraoperative bleeding, intraoperative blood transfusion, postoperative exhaust time, the first time out of bed, postoperative hospital stay, tube time, total hospitalization cost and postoperative complications were compared between the two groups. Results: There was no significant difference in the amount of surgical bleeding and the total cost of hospitalization between the two groups (P > 0.05). The operation time in group LPD was greater than that in group OPD (P < 0.05). The average postoperative exhaust time, the first time out of bed after operation, the length of hospital stay and the time of tube in group LPD were less than those in group OPD (P < 0.05). In group LPD, pancreatic fistula occurred in 5 cases, biliary fistula in 2 cases, abdominal infection in 8 cases, gastroparesis syndrome in 1 case, intraperitoneal hemorrhage in 2 cases, secondary operation in 3 cases and perioperative death in 2 cases; in group OPD, pancreatic fistula occurred in 4 cases, biliary fistula in 1 case, abdominal infection in 6 cases, gastroparesis syndrome in 5 cases, intraperitoneal hemorrhage in 3 cases, secondary operation in 2 cases, perioperative death in 1 case, and there were no obvious serious complications; there was no significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Conclusion: Both open and laparoscopic pancreatoduodenectomy are safe and effective, and laparoscopic pancreatoduodenectomy offers better postoperative recovery than open and laparoscopic pancreatoduodenectomy without increasing complications.