胰腺中段切除术经验总结(附177例报告)

doi:10.16139/j.1007-9610.2019.03.009

摘要/Abstract

摘要： 目的比较机器人胰腺中段切除术（robotic middle pancreatectomy,RMP）与开腹胰腺中段切除术（open middle pancreatectomy,OMP）的临床效果及术后并发症。方法回顾分析2010年12月至2017年12月我院外科RMP及OMP病人177例临床资料,其中RMP组115例,OMP组62例。包括术前一般资料和围术期临床资料。结果 RMP组病人男41例,女74例。平均年龄为（46.9±14.2）岁,术后生化胰漏14例（12.2%）,B级胰漏38例（33.0%）。术后平均住院时间RMP组（24.5±12.8） d,OMP组（23.3±17.8） d（P>0.05）。OMP组病人男25例,女37例,平均年龄为（53.0±13.7）岁,术后生化胰漏7例（11.3%）,B、C级胰漏14例（22.6%）。两组手术时间及术中出血量差异有统计学意义（P<0.001）。两组共14例术后出血,其中行介入血管造影栓塞6例,二次手术6例,1例行非手术治疗,RMP组1例因术后大出血死亡。OMP组1例因急性肺栓塞死亡。结论术后胰漏仍是胰腺中段切除术最常发生的并发症。RMP目前技术成熟安全,微创优势明显。

关键词: 胰腺肿瘤, 机器人手术, 胰腺中段切除术, 胰漏

Abstract: Objectives Clinical effect and postoperative complications were compared between robotic middle pancreatectomy (RMP) and open middle pancreatectomy (OMP). Methods Retrospective study was done with 177 patients of the demographics and perioperative data including 115 cases of RMP group and 62 cases of OMP group in our hospital from December 2010 to December 2017. Results There were 41 male and 74 female with mean age (46.9± 14.2) years in RMP group, and 25 male and 37 female with age (53.0± 13.7) years in OMP group. It was seen biochemical pancreatic leakage 14 cases (12.2%) in RMP group and 7 cases (11.3%) in OMP group. Only pancreatic leakage grade B was present 38 ca-ses (33%) in RMP group. Pancreatic leakage grade B and C were present 14 cases (22.6%) in OMP group. Length of hospital stay was (24.5± 12.8) days in RMP group and (23.3± 17.8) days in OMP group (P>; 0.05). There was significant difference in operative time and intraoperative blood loss between 2 groups(P< 0.001). A total of 14 cases were found postoperative bleeding with treatment of digital subtraction angiography in 6 cases and reoperation in 6 cases and nonoperative hemostasis in 1 case. There was 1 case death for severe postoperative bleeding and other case death for acute pulmonary embolism. Conclusions Postoperative pancreatic leakage is still main complication of both RMP and OMP. RMP could be safe now with advantages of minimal invasive surgery.

Key words: Pancreatic tumors, Robotic surgery, Middle pancreatectomy, Pancreatic leak

中图分类号:

R735.9

施昱晟, 王越, 秦凯, 翁原驰, 赵舒霖, 翟述昱, 唐笑梅, 霍震, 邓侠兴, 沈柏用, 彭承宏. 胰腺中段切除术经验总结(附177例报告)[J]. 外科理论与实践, 2019, 24(03): 215-221.

SHI Yusheng, WANG Yue, QIN Kai, WENG Yuanchi, ZHAO Shulin, ZHAI Shuyu, TANG Xiaomei, HUO Zhen, DENG Xiaxing, SHEN Baiyong, PENG Chenghong. Experience of robotic middle pancreatectomy: a report of 177 cases[J]. Journal of Surgery Concepts & Practice, 2019, 24(03): 215-221.

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