Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China.
Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China.
Int J Surg. 2018 Mar;51:170-173. doi: 10.1016/j.ijsu.2018.01.038. Epub 2018 Feb 2.
Few studies on the uncinate process-first approach in laparoscopic pancreaticoduodenectomy (LPD) have been reported. The aim of this study is to compare the perioperative outcomes of LPD to open pancreaticoduodenectomy (OPD) in terms of feasibility, safety, and efficacy using the uncinate process-first approach.
This retrospective study included 102 patients who underwent pancreaticoduodenectomy between 2013 and 2017. Patients were divided into two groups based on the surgical approach: the laparoscopic surgery group (n = 47) and open surgery group (n = 55). The clinical characteristics and intra- and postoperative data were retrospectively analysed.
LPD was performed successfully in all 47 patients. The mean operation time was significantly longer in the LPD group (410 ± 68 min) than in the OPD group (245 ± 70 min; P < 0.05). LPD produced significantly less intraoperative blood loss (210 ± 46 mL vs 420 ± 50 mL, P < 0.05), shorter first flatus time (1.5 d vs 4 d, P < 0.05) and shorter diet start time (2 d vs 5 d, P < 0.05). The total hospital stay was significantly shorter in the LPD group, with a median of 13 ± 4 days versus 18 ± 5.5 days in the OPD group (P < 0.05). The postoperative complication rates of the LPD group and OPD group were 21.3% and 27.3%, respectively (P > 0.05). The rate of category I-II complications and rate of category III-IV complications did not significantly differ (P > 0.05). Pancreatic fistulae occurred in 6 patients (12.8%) in the LPD group and 8 patients (14.5%) in the OPD group (P = 0.67). Delayed gastric emptying occurred in 2 patients (4.26%) in the LPD group and 2 patients in the OPD group (3.63%; P = 0.79). Postpancreatectomy haemorrhage was not significantly different between the groups (2.13% vs 3.63%; P = 0.66).
LPD with the uncinate process-first approach combines the benefits of laparoscopy with a low risk of postoperative complications and high rate of curative resection.
关于腹腔镜胰十二指肠切除术（LPD）中使用钩突优先方法的研究较少。本研究旨在通过钩突优先方法比较 LPD 和开腹胰十二指肠切除术（OPD）的围手术期结果，评估其可行性、安全性和疗效。
本回顾性研究纳入了 2013 年至 2017 年间进行胰十二指肠切除术的 102 名患者。根据手术方式将患者分为两组：腹腔镜手术组（n=47）和开腹手术组（n=55）。回顾性分析了两组患者的临床特征和术中、术后资料。
所有 47 例 LPD 均顺利完成。LPD 组的平均手术时间明显长于 OPD 组（410±68 分钟比 245±70 分钟；P<0.05）。LPD 术中出血量明显较少（210±46 毫升比 420±50 毫升；P<0.05），首次肛门排气时间更短（1.5 天比 4 天；P<0.05），开始进食时间更短（2 天比 5 天；P<0.05）。LPD 组的总住院时间明显更短，中位数为 13±4 天，而 OPD 组为 18±5.5 天（P<0.05）。LPD 组和 OPD 组的术后并发症发生率分别为 21.3%和 27.3%（P>0.05）。I-II 类并发症发生率和 III-IV 类并发症发生率差异均无统计学意义（P>0.05）。LPD 组发生胰瘘 6 例（12.8%），OPD 组发生胰瘘 8 例（14.5%）（P=0.67）。LPD 组和 OPD 组的胃排空延迟发生率分别为 4.26%和 3.63%（P=0.79）。两组术后出血发生率差异无统计学意义（2.13%比 3.63%；P=0.66）。
钩突优先的 LPD 结合了腹腔镜的优势，具有较低的术后并发症风险和较高的根治性切除率。
