中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (02): 187-194.DOI: 10.19538/j.cjps.issn1005-2208.2025.02.11

• 论著 • 上一篇    下一篇

单孔+1与传统腹腔镜胰十二指肠切除术安全性与实用性对比研究

杨陈凤麟1，李    尧1，陈品初1，李芷西1，丁洁茹2，卫姝冰3，张    潇3，张起帆1   

  1. 1.南方医科大学南方医院普通外科学肝胆胰外科，广东广州 510515；2.南方医科大学第二临床医学院，广东广州 510280；3.南方医科大学第一临床医学院，广东广州 510515
  • 出版日期:2025-02-01 发布日期:2025-02-26

  • Online:2025-02-01 Published:2025-02-26

摘要： 目的    报道单孔+1腹腔镜胰十二指肠切除术（SILPD+1）手术经验，并对比其与传统“5孔法”腹腔镜胰十二指肠切除术（CLPD）在安全性和实用性方面的差异。方法    回顾性分析2023年2月至2024年4月期间于南方医科大学南方医院肝胆胰外科行腹腔镜胰十二指肠切除术的49例病人的临床资料，其中14例病人行SILPD+1，35例病人行5孔法CLPD。结果    两组病人基线资料差异无统计学意义（P>0.05）。两组中转开放手术比例差异无统计学意义（χ2=0.006，P=0.941）。后续不再纳入开放病例的术中、术后数据，实际对12例SILPD+1和32例 CLPD做进一步统计分析。与CLPD组相比，SILPD+1组病人术中失血量［150.0（100.0，287.5） mL vs. 65.0（50.0，137.5）mL，Z=-2.862，P=0.004］和术后住院时长［15.7（11.9，21.1） d vs. 11.2（10.0，14.9） d，Z=-2.109，P=0.035］均较少，术后疼痛评分更低［第3天：4.0（3.3，5.0）分 vs. 3.0（2.0，4.0）分，Z=-2.715，P=0.007；第5天：3.0（2.0, 3.0）分 vs. 2.0（1.0，3.0）分，Z=-2.150，P=0.032］，恢复质量评分更高［第3天：63.0（58.0，68.8）分 vs. 72.5（68.3，75.8）分，Z=-3.536，P<0.001；第5天：88.0（81.3，95.0）分 vs. 98.5（93.0，107.3）分，Z=-3.364，P=0.001］，切口美观度评分更高（χ2=4.805，P=0.028），差异有统计学意义。两组手术时长、术中重要血管意外损伤、离床活动时间、肛门排气时间、并发症发生率、术者疲劳程度评分等差异无统计学意义（P>0.05）。结论    对于有丰富经验的胰腺外科医生而言，SILPD+1是安全可行的，在加速围手术期康复、疼痛控制和恢复质量提升方面存在优势，同时不会明显增加术者的疲劳感。

关键词: 胰十二指肠切除术, 单孔+1孔, 腹腔镜手术, 近期疗效

Abstract: To report the surgical experience of single-incision plus one port laparoscopic pancreaticoduodenectomy (SILPD+1) and to compare its safety and practicality with that of conventional five-port laparoscopic pancreaticoduodenectomy (CLPD). Methods    The clinical data of 49 patients who underwent LPD at the Department of Hepatobiliary and Pancreatic Surgery, Nanfang Hospital, Southern Medical University, between February 2023 and April 2024 were retrospectively analyzed, among which 14 patients underwent SILPD+1 and 35 patients underwent CLPD.  Results    There was no statistically significant differences in the baseline data of the patients in the two groups (P>0.05) and the rate of conversion to open surgery (χ2=0.006, P=0.941). Subsequently, the intraoperative and postoperative data of open cases were no longer included, and further statistical analysis was carried out on 12 cases of SILPD+1 and 32 cases of CLPD. Compared with the CLPD group, patients in the SILPD+1 group had intraoperative blood loss ［150.0 (100.0,287.5) mL vs. 65.0 (50.0,137.5) mL , Z=-2.862, P=0.004］ and postoperative hospital stay length ［15.7 (11.9, 21.1) d vs. 11.2 (10.0, 14.9) d, Z=-2.109, P=0.035］ were less, with lower postoperative pain scores ［day 3: 4.0 (3.3, 5.0) points vs. 3.0 (2.0, 3.0) points, Z=-2.715, P=0.007; day 5: 3.0 (2.0, 4.0) d vs. 2.0 (1.0, 3.0) d, Z=-2.150, P=0.032］. The quality of recovery scores were higher ［day 3: 63.0 (58.0, 68.8) points vs. 72.5 (68.3, 75.8)points, Z=-3.536, P<0.001; day 5:  88.0 (81.3, 95.0) points vs. 98.5 (93.0, 107.3) points, Z=-3.364, P=0.001］, and the satisfaction with incision was higher (χ2=4.805, P=0.028), and these differences were statistically significant. There was no statistically significant differences between the two groups in terms of the length of surgery, intraoperative accidental injury of important blood vessels, activities away from the bed, anal exsufflation, complication rate, and surgeon fatigue score (P>0.05).  Conclusion    For experienced pancreatic surgeons, SILPD+1 is safe and feasible, with advantages in accelerating perioperative recovery, pain control, and quality of recovery enhancement, without significantly increasing operator fatigue.

Key words: laparoscopic pancreaticoduodenectomy, single-incision plus one port, laparoscopic surgery, recent efficacy