中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (05): 570-575.DOI: 10.19538/j.cjps.issn1005-2208.2025.05.17

• 论著 • 上一篇    下一篇

腹腔镜保留十二指肠全胰头切除术可行性与安全性研究

李昌旭1，徐    盟2，肖    黎2，王    兵2，段希斌1，朱    峰2   

  1. 1郑州大学附属郑州中心医院肝胆胰外科，河南郑州 450000；2华中科技大学同济医学院附属同济医院胆胰外科，湖北武汉 430000
  • 出版日期:2025-05-01 发布日期:2025-05-28

  • Online:2025-05-01 Published:2025-05-28

摘要： 目的    探讨腹腔镜保留十二指肠全胰头切除术（LDPTPHR）的临床疗效。方法    回顾性分析2020年4月至2024年6月华中科技大学同济医学院附属同济医院胆胰外科行LDPTPHR病人（70例）及同期行腹腔镜胰十二指肠切除术（LPD）病人（70例）的围手术期及院外随访资料。结果    LDPTPHR组肿瘤最大径小于LPD组，差异有统计学意义［2.4（2.0，3.3）cm vs. 3.0（2.3，3.7）cm， P=0.001］。LDPTPHR组手术时间 ［（205.6±30.4）min vs. （246.7±36.8）min， P＜0.001］、胃管留置时间［25.2（23.0，29.9）h vs. 44.7（40.3，49.0）h， P＜0.001］、术后饮水时间［34.1（29.9，36.3）h vs. 53.0（48.7，57.1）h，P＜0.001］、术后进食时间［41.6（39.5，44.8） h vs. 61.5（56.3，65.7）h， P＜0.001］，并发症Clavien-Dindo分级各级比例（Z=2.597， P=0.009），胰肠吻合口腹腔引流管拔管时间［10.0（9.0，12.0）d vs. 12.0（11.0，14.0）d，P＜0.001］，术后住院时间［（11.4±3.1）d vs， （16.4±2.9）d， P＜0.001］均短于LPD组，末次随访LDPTPHR组美国东部肿瘤协作组体力状况评分（ECOG PS）优于LPD组（χ2=5.414，P=0.020），差异有统计学意义。两组胰肠吻合时间，术中出血量，胰瘘、胆瘘、乳糜瘘、胃排空延迟、腹腔感染、术后出血、胆总管结石、胆管狭窄的发生率，30 d再入院比例，再次手术比例等指标差异无统计学意义（P>0.05）。结论    在治疗胰头低度恶性、交界性、良性疾病方面，与LPD对比，LDPTPHR安全可行。

关键词: 腹腔镜, 保留十二指肠全胰头切除术, 胰十二指肠切除术, 手术并发症

Abstract: To investigate the clinical efficacy of laparoscopic duodenal total pancreatic head resection (LDPTPHR). Methods    A retrospective analysis was conducted on the perioperative and postoperative follow-up data of 70 patients who underwent LDPTPHR and 70 patients who underwent laparoscopic pancreaticoduodenectomy (LPD) at the Department of Hepatobiliary and Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between April 2020 and June 2024. Results    There was a statistically significant difference in the maximum tumor diameter between the LDPTPHR group and the LPD group ［2.4 (2.0, 3.3) cm vs. 3.0 (2.3, 3.7) cm, P=0.001］. The LDPTPHR group had shorter operation time ［(205.6±30.4) min vs. (246.7±36.8) min, P<0.001］, shorter gastric tube retention time ［25.2 (23.0, 29.9) h vs. 44.7 (40.3, 49.0) h, P<0.001］, earlier postoperative drinking time ［34.1 (29.9, 36.3) h vs. 53.0 (48.7, 57.1) h, P<0.001］, earlier postoperative eating time ［41.6 (39.5, 44.8) h vs. 61.5 (56.3, 65.7) h, P<0.001］, lower proportion of Clavien-Dindo complication grades (Z=2.597, P=0.009), earlier removal of pancreaticojejunostomy abdominal drainage tube ［10.0 (9.0, 12.0) d vs. 12.0 (11.0, 14.0) d, P<0.001］, and shorter postoperative hospital stay ［(11.4±3.1) d vs. (16.4±2.9) d, P<0.001］ compared with the LPD group. At the last follow-up, the ECOG PS score of the LDPTPHR group was better than that of the LPD group (χ2=5.414, P=0.020), with a statistically significant difference. There was no statistically significant difference in the pancreaticojejunostomy time, intraoperative blood loss, incidence of pancreatic fistula, incidence of biliary fistula, incidence of chylous fistula, incidence of delayed gastric emptying, incidence of abdominal infection, postoperative bleeding rate, incidence of common bile duct stones, incidence of biliary stricture, 30 d readmission rate, and reoperation rate between the two groups (P>0.05). Conclusion  In the treatment of low-grade malignant, borderline and benign diseases of the pancreatic head, LDPTPHR is safe and feasible compared with LPD.

Key words: laparoscope, duodenum-preserving total pancreatic head resection, pancreaticoduodenectomy, surgical complications