Cheng J F, Li X M, Wu X K, Yuan H, Yu S A
Department of Hepatopancreatobiliary Surgery, Jinhua Hospital, Affiliated to Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China.
Zhonghua Wai Ke Za Zhi. 2020 Dec 1;58(12):918-923. doi: 10.3760/cma.j.cn112139-20200408-00287.
To compare the short-term results of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in periampullary carcinoma patients. The clinical data of patients with periampullary carcinoma who underwent laparoscopic pancreaticoduodenectomy or open pancreaticoduodenectomy at Department of Hepatopancreatobiliary Surgery, Jinhua Hospital, Affiliated to Zhejiang University School of Medicine from January 2013 to February 2018 were collected. Totally 127 patients were included in the study. There were 73 males and 54 females, aged (61.2±9.4) years (range: 37-80 years). Propensity score matching method was used to perform 1∶1 matching between laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Perioperative outcomes and overall survival were compared between the two groups using test, χ(2) test, Fisher exact probability, Kaplan-Meier curve and Log-rank test, respectively. A total of 32 pairs of patients were successfully matched by propensity score matching. There were 21 males and 11 females in open pancreaticoduodenectomy group, aged (62.1±9.3)years, 21 males and 11 females in laparoscopic group, aged (63.7±9.4)years. Comparion with open pancreaticoduodenectomy, the laparoscopic group had longer operative time (381(47)minutes . 249(92)minutes)(5.949,0.000), higher hospitalization cost ((64.8±7.2) thousand yuan . (56.0±9.2)thousand yuan, 3.464, 0.001), but less in estimated blood loss ((249.38±91.40)ml .(329.69±120.26)ml) (3.008, 0.004), shorter in the time to first flatus ((3.39± 1.1)days . (5.03±1.65)days, 5.316, 0.000) and preoperative hospital stay((18.6±5.59)days . (21.9±5.5)days) (2.242, 0.018). There was no significant difference in vascular invasion, nerve invasion, number of lymph nodes dissected, perioperative complications and pathology (all 0.05). After PSM, there was no significant difference found in 1-year overall survival rate (60.0% . 62.0%, 0.729). Laparoscopic pancreaticoduodenectomy is safe and feasible for the treatment of periampullary carcinoma. It not only has advantages of less trauma and faster recovery, but also achieves similar of lymph node dissection and equivalent short-term prognosis when compared with open approach.
比较腹腔镜胰十二指肠切除术与开腹胰十二指肠切除术治疗壶腹周围癌患者的短期疗效。收集2013年1月至2018年2月在浙江大学医学院附属金华医院肝胆胰外科行腹腔镜胰十二指肠切除术或开腹胰十二指肠切除术的壶腹周围癌患者的临床资料。共纳入127例患者。其中男性73例，女性54例，年龄（61.2±9.4）岁（范围：37 - 80岁）。采用倾向评分匹配法对腹腔镜胰十二指肠切除术和开腹胰十二指肠切除术进行1∶1匹配。分别采用t检验、χ²检验、Fisher确切概率法、Kaplan - Meier曲线和Log - rank检验比较两组患者的围手术期结局和总生存期。通过倾向评分匹配成功匹配了32对患者。开腹胰十二指肠切除术组有男性21例，女性11例，年龄（62.1±9.3）岁；腹腔镜组有男性21例，女性11例，年龄（63.7±9.4）岁。与开腹胰十二指肠切除术相比，腹腔镜组手术时间更长（381（47）分钟 对 249（92）分钟）（5.949，0.000），住院费用更高（（64.8±7.2）千元 对 （56.0±9.2）千元，3.464，0.001），但估计失血量更少（（249.38±91.40）ml 对（329.69±120.26）ml）（3.008，0.004），首次排气时间更短（（3.39±1.1）天 对 （5.03±1.65）天，5.316，0.000），术前住院时间更短（（18.6±5.59）天 对 （21.9±5.5）天）（2.242，0.018）。在血管侵犯、神经侵犯、清扫淋巴结数目、围手术期并发症及病理方面差异均无统计学意义（均P＞0.05）。倾向评分匹配后，1年总生存率差异无统计学意义（60.0% 对 62.0%，0.729）。腹腔镜胰十二指肠切除术治疗壶腹周围癌安全可行。与开腹手术相比，不仅创伤小、恢复快，而且淋巴结清扫效果相近，短期预后相当。
