腹腔镜下胰腺全系膜切除治疗胰头癌的临床疗效分析

doi:10.3877/cma.j.issn.1674-3946.2019.01.029

目的

探讨腹腔镜下胰腺全系膜切除治疗胰头癌的临床疗效。

方法

回顾性分析2013年4月至2016年4月46例胰头癌患者资料，根据手术术式的差异分为腹腔镜组(25例)和开腹组(21例)，腹腔镜组行腹腔镜下胰腺全系膜切除术，开腹组行开腹胰十二指肠切除术。采用SPSS 19.0统计学软件进行统计分析，术前和术后相关指标以均数±标准差表示，组间比较采用独立t检验；R0切除率、术后并发症发生率采用χ²检验，以P<0.05表示差异有统计学意义。

结果

腹腔镜组患者的R0切除率为88.0%，开腹组患者为61.9%(P<0.05)；与开腹组相比，腹腔镜组患者的手术时间显著增加，而术中出血量及术中输血量均显著减少(P<0.05)；与开腹组相比，腹腔镜组患者的术后肛门排气时间、进食流质食物时间及住院时间均显著缩短(P<0.05)；腹腔镜组患者术后并发症的发生率16.0%，开腹组42.9%，差异具有统计学意义(P<0.05)。

结论

腹腔镜下胰腺全系膜切除治疗胰头癌的临床疗效较好，且安全性较高，值得在临床上推广应用。

关键词: 胰腺肿瘤, 腹腔镜, 胰腺切除术, 治疗结果

Objective

To investigate the clinical effect and security of laparoscopic total mesopancreas excision in the treatment of pancreatic head carcinoma.

Methods

46 cases of pancreatic head carcinoma were collected from April 2013 to April 2016 in our hospital and conducted a retrospective analysis. According to the different surgical methods, the patients were divided into laparoscope group (25 cases) and open surgery group (21cases), the laparoscope group was given laparoscopic total mesopancreas excision surgery, the open surgery group was given open pancreaticoduodenectomy. Statistical analysis were performed by using SPSS 19.0 software, preoperative and postoperative related indicators were presented as and examined by using t test; enumeration data (excision rate of R0, the incidence of the complications after operation) was examined by chi square test. A P<0.05 was considered as significant difference.

Results

The excision rate of R0 in laparoscope group was 88.0%, the excision rate of R0 in open surgery group was 61.9% (P<0.05). Compared with the open surgery group, the operation time of the laparoscope group was significantly increased, but the intraoperative blood loss and intraoperative transfusion were significantly decreased (P<0.05); Compared with the open surgery group, the postoperative anal exhaust time, eat liquid food time and hospital stays of the laparoscope group were significantly shortened (P<0.05). The incidence of postoperative complications of the laparoscope group was 16.0%, the incidence of postoperative complications of the open surgery group was 42.9%, the difference was statistically significant (P<0.05).

Conclusion

Laparoscopic total mesopancreas excision in the treatment of pancreatic head carcinoma has good clinical effect and security, it is worth promoting the application in clinic.

Key words: Pancreatic neoplasms, Laparoscopes, Pancreatectomy, Treatment outcome

表1 46例胰头癌患者不同术式两组患者一般临床资料的比较(±s)

组别	例数	男性(例)	年龄(岁)	BMI(kg/m²)
腹腔镜组	25	13(52.0)	51.7±13.5	23.5±2.6
开腹组	21	10(47.6)	53.5±12.9	23.2±3.1
t/χ²值	－	0.088	0.462	0.356
P值	－	0.767	0.646	0.723

表1 46例胰头癌患者不同术式两组患者一般临床资料的比较(±s)

组别	例数	男性(例)	年龄(岁)	BMI(kg/m²)
腹腔镜组	25	13(52.0)	51.7±13.5	23.5±2.6
开腹组	21	10(47.6)	53.5±12.9	23.2±3.1
t/χ²值	－	0.088	0.462	0.356
P值	－	0.767	0.646	0.723

表2 46例胰头癌患者不同术式两组患者术中相关指标的比较(±s)

组别	例数	R0切除率[例(%)]	手术时间(h)	术中出血量(ml)	术中输血量(ml)
腹腔镜组	25	22(88.0)	6.5±1.8	651.9±97.1	621.5±85.2
开腹组	21	13(61.9)	4.2±1.1	728.4±124.9	702.3±94.7
t/χ²值	－	4.271	5.104	2.337	3.045
P值	－	0.039	0.000	0.024	0.004

表2 46例胰头癌患者不同术式两组患者术中相关指标的比较(±s)

组别	例数	R0切除率[例(%)]	手术时间(h)	术中出血量(ml)	术中输血量(ml)
腹腔镜组	25	22(88.0)	6.5±1.8	651.9±97.1	621.5±85.2
开腹组	21	13(61.9)	4.2±1.1	728.4±124.9	702.3±94.7
t/χ²值	－	4.271	5.104	2.337	3.045
P值	－	0.039	0.000	0.024	0.004

表3 46例胰头癌患者不同术式两组患者术后相关指标的比较(±s)

组别	例数	术后肛门排气时间(d)	进食流质食物时间(d)	住院时间(d)
腹腔镜组	25	2.9±1.3	4.9±1.9	10.7±3.9
开腹组	21	3.7±1.1	6.1±1.5	13.1±2.3
t值	－	2.238	2.344	2.479
P值	－	0.031	0.024	0.017

表3 46例胰头癌患者不同术式两组患者术后相关指标的比较(±s)

组别	例数	术后肛门排气时间(d)	进食流质食物时间(d)	住院时间(d)
腹腔镜组	25	2.9±1.3	4.9±1.9	10.7±3.9
开腹组	21	3.7±1.1	6.1±1.5	13.1±2.3
t值	－	2.238	2.344	2.479
P值	－	0.031	0.024	0.017

表4 46例胰头癌患者不同术式两组患者术后并发症发生率的比较[例(%)]

组别	例数	胰瘘	消化道或腹腔出血	胆漏	总发生率
腹腔镜组	25	1(4.2)	2(8.0)	1(4.2)	4(16.0)
开腹组	21	3(14.3)	4(19.1)	2(9.5)	9(42.9)
χ²值	－	1.521	1.228	0.571	7.142
P值	－	0.217	0.268	0.450	0.008

表4 46例胰头癌患者不同术式两组患者术后并发症发生率的比较[例(%)]

组别	例数	胰瘘	消化道或腹腔出血	胆漏	总发生率
腹腔镜组	25	1(4.2)	2(8.0)	1(4.2)	4(16.0)
开腹组	21	3(14.3)	4(19.1)	2(9.5)	9(42.9)
χ²值	－	1.521	1.228	0.571	7.142
P值	－	0.217	0.268	0.450	0.008

[1]	Schietroma M, Pessia B, Carlei F, et al. Intestinal permeability changes, systemic endotoxemia, inflammatory serum markers and sepsis after Whipple's operation for carcinoma of the pancreas head[J]．Pancreatology, 2017, 17(5): 839-846.
[2]	Park SY, Park KM, Shin WY, et al. Functional and morphological evolution of remnant pancreas after resection for pancreaticadenocarcinoma[J]．Medicine, 2017, 96(28): e7495.
[3]	Gilabert M, Boher JM, Raoul JL, et al. Comparison of preoperative imaging and pathological findings for pancreatic headadenocarcinoma: A retrospective analysis by the Association Fran？aise de Chirurgie[J]．Medicine, 2017, 96(24): e7214.
[4]	Wu W, Wang X，Wu X, et al. Total mesopancreas excision for pancreatic head cancer: analysis of 120 cases[J]. Chin J Cancer Res, 2016, 28(4): 423-428.
[5]	Gilabert M, Chanez B, Rho YS, et al. Evaluation of gemcitabine efficacy after the FOLFIRINOX regimen in patients with advancedpancreatic adenocarcinoma[J]. Medicine, 2017, 96(16): e6544.
[6]	Sakamoto Y, Fujikawa T, Tanaka A. Successful radical resection of pancreatic head carcinoma in a patient with replaced right hepatic artery originating from posterior inferior pancreaticoduodenal artery: a case report[J]. Surg Case Rep, 2017, 3(1): 78-78.
[7]	马春阳，朱峰，肖光勤，等. 植入式胰管空肠吻合术在全腹腔镜胰十二指肠切除术中的应用研究[J]. 中国普外基础与临床杂志，2016, 23(4): 388-392.
[8]	戴梦华．腹腔镜下半旋转胰头动脉优先入路胰十二指肠切除术的临床意义[J/CD]．中华普外科手术学杂志(电子版)，2018，12(4):275-278.
[9]	李汉华，王慧玲，区应亮，等. PET/CT及肿瘤病理特征与胰头癌手术预后的关系[J]. 广东医学，2015, 36(6): 896-898.
[10]	刘颖斌，吴文广．胰腺全系膜切除理念争议及评价[J]．中国实用外科杂志，2016, 36(8): 836-838.
[11]	庄岩，田孝东，高红桥，等. 腹腔镜胰十二指肠切除术的难点与争议[J/CD]．中华普外科手术学杂志(电子版), 2018, 12(4):271-274.
[12]	Duconseil P, Périnel J, Autret A, et al. Resectable invasive IPMN versus sporadic pancreatic adenocarcinoma of the head of thepancreas: Should these two different diseases receive the same treatment? A matched comparison study of the French Surgical Association (AFC)[J]. Eur J Surg Oncol，2017，43(9): 1704-1710.
[13]	黄鹤光，林荣贵．腹腔镜前入路静脉优先与右后入路动脉优先联合切除钩突的优势[J/CD]．中华普外科手术学杂志(电子版)，2018，12(4):279-282.
[14]	Terakawa H，Kitagawa H，Makino I，et al. Location of the meso－pancreatoduodenum as a regional lymphatic basin for pancreatic headcarcinoma[J]. Oncol Lett，2017，14(1): 397-403.
[15]	Zhou Y，Wang HJ. Occurrence pattern and impact of lymph node micrometastasisi pancreatic head cancer[J]. Zhonghua Zhong Liu Za Zhi, 2017, 39(9): 664-667.
[16]	张建生，王天阳，刘润田，等. 胰腺全系膜切除用于腹腔镜胰头癌根治术34例疗效分析[J]. 中国实用外科杂志，2017，37(4): 447-451.

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[10]	李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
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[15]	叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.

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Clinical effect of laparoscopic total mesopancreas excision in the treatment of pancreatic head carcinoma

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Clinical effect of laparoscopic total mesopancreas excision in the treatment of pancreatic head carcinoma