腹腔镜胰十二指肠切除术在老年病人中的可行性分析

doi:10.16139/j.1007-9610.2020.01.013

摘要/Abstract

摘要：

目的： 研究腹腔镜胰十二指肠切除术在老年病人的围术期手术疗效,评价安全性及可行性。方法： 回顾性分析自2015年1月至2018年1月在我院普外科完成腹腔镜胰十二指肠切除术病人的临床资料。分为老年组（≥70岁组）和对照组（<70岁组）。比较两组一般资料以及围术期手术学疗效。结果： 82例病人中,男46例,女36例,平均年龄（64.6±10.7）岁,老年组27例,对照组55例。老年组平均手术时间（368±75） min,中位术中出血量200（100~400） mL,中位术后住院时间12（10~21） d。对照组平均手术时间（363±82） min,中位术中出血量100（100~200） mL,中位术后住院时间11.5（10~16） d。两组数据差异无统计学意义。两组术后90 d内死亡率差异无统计学意义,但老年组术后严重并发症总发生率（40.7%）高于对照组（20.0%）（P=0.05）。结论： 腹腔镜胰十二指肠切除术在老年病人中可行。由于老年病人术后并发症发生率高于普通病人,因此,实施时仍需十分谨慎。

关键词: 胰十二指肠切除术, 胰腺手术, 腹腔镜, 微创手术, 老年人

Abstract:

Objective To evaluate the feasibility of laparoscopic pancreaticoduodenectomy in elderly patients with peri-operative short-term outcomes and safety. Methods Retrospectively analysis was done with the clinical data of patients who underwent laparoscopic pancreaticoduodenectomy in our department from January 2015 to January 2018. Patients were divided into elderly group (ages 70 years and old) and control group (ages less than 70 years) to compare baseline characteristics and perioperative outcomes between two groups. Results Totally 82 patients were included in this study with 46 male and 36 female and mean age (64.6±10.7) years. There were 27 patients in elderly group and 55 patients in control group. Mean operative time was (368±75) min in elderly group with median blood loss 200 (100-400) mL and median postoperative length of hospital stay 12.0 (10-21)d. In control group, mean operation time was (363±82) min with median blood loss 100 (100-200) mL and median postoperative length of hospital stay 11.5 (10-16) d. There was no statistics difference between two groups. Postoperative 90-day mortality rate was not different statistically between two groups patients. However, higher postoperative morbidity rate was found in elderly group patients (40.7%) more than that in control group patients (20.0%) (P=0.05). Conclusions Laparoscopic pancreaticoduodenectomy was feasible in elderly patients. Relatively higher postoperative morbidity rate of elderly patients should be cautioned when laparoscopic pancreaticoduodenectomy was performed in elderly patients.

Key words: Pancreaticoduodenectomy, Pancreatic surgery, Laparoscopy, Minimally invasive surgery, Elderly patient

中图分类号:

R735.9

梁贇, 姜翀弋, 赵丽亭, 王宏伟, 胡鹏飞, 蔡志伟, 王巍. 腹腔镜胰十二指肠切除术在老年病人中的可行性分析[J]. 外科理论与实践, 2020, 25(01): 60-64.

LIANG Yun, JIANG Chongyi, ZHAO Liting, WANG Hongwei, HU Pengfei, CAI Zhiwei, WANG Wei. Laparoscopic pancreaticoduodenectomy in elderly patients: a feasibility study[J]. Journal of Surgery Concepts & Practice, 2020, 25(01): 60-64.

图/表 2

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参考文献 18

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指标	老年组（n=27）	对照组（n=55）	统计学数值	P值
年龄（岁）	74.4±3.8	58.9±9.2	t=-8.43	<0.001
性别(男/女)	16/11	30/25	χ²=0.16	0.81
BMI	22±4	22±3	t=0.86	0.41
ASA评分			χ²=18.74	<0.001
Ⅰ (n)	0	12(21.8%)	-	-
Ⅱ (n)	19(70.4%)	42(76.4%)	-	-
Ⅲ (n)	8(29.6%)	1(1.8%)	-	-
病理
恶性肿瘤(n)	24(88.9%)	36(65.5%)^a)	χ²=5.07	0.03
胰腺导管腺癌^c(n)	12(44.4%)	18(32.7%)	-	-
壶腹部周围癌(n)	12(44.4%)	17(30.9%)	-	-
良性肿瘤
导管内乳头状黏液性肿瘤(n)	0	7(12.7%)	-	-
实体假乳头瘤（n）	0	1(1.8%)	-	-
神经内分泌肿瘤(n)	1(3.7%)	2(3.6%)	-	-
浆液性囊腺瘤(n)	1(3.7%)	5(9.1%)	-	-
其他肿瘤(n)	1(3.7%)	5(9.1%)	-	-
肿瘤直径(cm）	2.6±1.0	2.8±1.4	t=0.56	0.55
R0切除（n）	23/24(95.8%)	34/36(94.4%)	χ²=0.000 1	0.97
清扫淋巴结数（枚）	12.6±5.3	12.4±7.5	t=-0.15	0.86

指标	老年组（n=27）	对照组（n=55）	统计学数值	P值
手术时间（min）	368±75	363±82	t=-0.24	0.81
术中出血量（mL）^a)	200 (100~400)	100 (100~200)	z=-1.72	0.09
中转开腹（n）	2 (7.4%)	5 (9.1%)	χ²=0.07	1.00
术后住院时间（d）^a)	12.0 (10~21)	11.5 (10~16)	z=-1.50	0.13
术后ICU入住病人数（n）	10 (37.0%)	14 (25.5%)	χ²=1.17	0.31
ICU时间 (d)^a)	7 (4~10)	2 (2~5)	z=-2.56	0.01
B或C级术后胰漏（n）	4 (14.8%)	5 (9.1%)	χ²=0.56	0.47
腹腔感染（n）	5 (18.5%)	6 (10.9%)	χ²=0.84	0.49
术后出血（n）	4 (14.8%)	3 (5.5%)	χ²=1.95	0.21
胃排空障碍（n）	0	1 (1.8%)	χ²=0.51	1.00
再次手术（n）	3 (11.1%)	2 (3.6%)	χ²=1.71	0.33
Clavin-Dindo分级（n）
Ⅰ~Ⅱ	16	44	-	-
Ⅲ~V	11	11	-	-
严重并发症发生(n)	11 (40.7 %)	11 (20.0%)	OR=2.75(1.00~7.58)	0.05
术后90 d内死亡（n）	2 (7.4%)	1 (1.8%)	OR=4.32(0.37~49.90)	0.24