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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)治疗胰头癌的疗效。方法回顾性分析笔者所在医院科室于2004年10月至2009年10月期间收治的60例中晚期胰头癌患者的临床资料,其中26例行LPD(LPD组),34例行OPD(OPD组)。结果 LPD组患者的手术时间和住院费用长于(高于)OPD组(P<0.05),但LPD组的术中出血量、下床活动时间、术后排气时间、引流管拔出时间、胃肠道减压管拔出时间、绝对卧床时间及住院时间均短于(少于)OPD组(P<0.05)。术后25例患者发生并发症,其中LPD组10例,OPD组15例,2组患者的总并发症发生率比较差异无统计学意义(P>0.05)。其中,LPD组的胰瘘和胆瘘发生率均高于OPD组(P<0.05),而切口感染、肺部感染及全身感染发生率均低于OPD组(P<0.05)。60例患者术后均获访,随访时间1~60个月(中位数为21.5个月)。随访期间,LPD组复发24例,转移20例,死亡24例;OPD组复发31例,转移25例,死亡31例。2组患者的复发率、转移率及死亡率比较差异均无统计学意义(P>0.05),且2组患者的生存曲线比较差异也无统计学意义(P>0.05)。结论对胰头癌而言,LPD在术后患者恢复及感染并发症发生情况方面均明显优于OPD,而在减少胰瘘、胆瘘、胃排空延迟等并发症及提高远期生存率方面与OPD比较无明显优越性。
Objective To compare the efficacy of laparoscopic pancreatoduodenectomy (LPD) and open pancreatoduodenectomy (OPD) in the treatment of pancreatic cancer. Methods The clinical data of 60 patients with advanced pancreatic head cancer admitted to our hospital department from October 2004 to October 2009 were retrospectively analyzed. Among them, 26 patients underwent LPD (LPD group) and 34 patients underwent OPD (OPD group) ). Results The operation time and hospitalization cost of patients in LPD group were longer than those in OPD group (P <0.05), but the blood loss of LPD group, the time of bed ambulation, the time of postoperative exhaust, the drainage time of drainage tube, Intestinal decompression tube extraction time, absolute bed rest and hospital stay were shorter than (less than) OPD group (P <0.05). Complications occurred in 25 patients after operation, including 10 cases in LPD group and 15 cases in OPD group. There was no significant difference in the total complication rates between the two groups (P> 0.05). Among them, the incidences of pancreatic fistula and biliary fistula in LPD group were higher than those in OPD group (P <0.05), but the incidence of incision infection, pulmonary infection and systemic infection were lower than that of OPD group (P <0.05). All 60 patients were followed up for 1 ~ 60 months (median 21.5 months). During the follow-up period, 24 cases were recurred in LPD group, 20 cases were transferred and 24 died. In OPD group, 31 cases were recurred, 25 cases were transferred and 31 died. There was no significant difference in recurrence rate, metastasis rate and mortality between the two groups (P> 0.05). There was no significant difference in survival curves between the two groups (P> 0.05). Conclusions For pancreatic cancer, LPD is superior to OPD in the recovery of postoperative patients and the incidence of complications. However, in reducing pancreatic fistula, biliary fistula, delayed gastric emptying and improving the long-term survival rate No obvious superiority compared with OPD.