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三维腹腔镜与二维腹腔镜胰十二指肠切除术的应用比较

Comparison of the clinical application of three-dimensional and two-dimensional laparoscopic pancreaticoduodenectomy

摘要:

目的 比较三维(3D)腹腔镜与二维(2D)腹腔镜胰十二指肠切除术(LPD)的临床应用效果.方法 回顾性分析2017年3月至2018年8月于常州市第一人民医院肝胆胰外科接受LPD的90例患者的资料,其中3D-LPD组45例,2D-LPD组45例.对比两组患者的术中情况、术后并发症及术后病理学指标的差异.计量资料的比较采用独立样本t检验、计数资料的比较采用x2检验或Fisher确切概率法.结果 3D-LPD和2D-LPD组患者的基线资料具有可比性(P值均>0.05).3D-LPD组与2D-LPD组手术时间的差异有统计学意义[(335±95) min比(419±113) min,t=-3.817,P=0.000],3D-LPD组消化道重建的时间更短[(92±26)min比(131±46)min,t=-4.951,P=0.000].3D-LPD组术中出血量明显少于2D-LPD手术组[(242±124)ml比(350±176)ml,t=-3.365,P=0.001],3D-LPD组围手术期输血例数少于2D-LPD手术组(x2=4.444,P=0.035).两组术后住院天数、ICU监护时间的差异均无统计学意义(P值均>0.05).两组术后并发症如胰瘘、胆瘘、术后出血、胃排空延长、腹腔感染的差异亦无统计学意义(P值均>0.05).结论 3D-LPD比2D-LPD的手术时间短,出血量少,近期临床结果显示其安全、有效,值得进一步推广.

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abstracts:

Objective To compare the clinical application of three-dimensional laparoscopic pancreatoduodenectomy(3D-LPD) with that of two-dimensional laparoscopic pancreatoduodenectomy (2D-LPD),and to explore the safety and feasibility of 3D-LPD.Methods A retrospective analysis was made from the data of 45 patients with 3D-LPD and 45 patients with 2D-LPD who underwent total laparoscopic pancreatoduodenectomy from March 2017 to August 2018 at Department of Hepato-Pancreato-Biliary Surgery,the First People's Hospital of Changzhou.The differences of intraoperative conditions,postoperative complications and postoperative pathological findings between the two methods were compared.Measurement data were compared with independent sample t-test,enumeration data were statistically analyzed with Chi-square test or Fisher exact probability.Results The operation time of 3D-LPD group was shorter than that of 2D-LPD group ((335±95)min vs.(419± 113)min,t=-3.817,P=0.000),which mainly showed that the time of digestive tract reconstruction was reduced ((92 ± 26)min vs.(131 ± 46)min,t=-4.951,P=0.000).The intraoperative blood loss in the 3D-LPD group was significantly less than that in the 2D-LPD group((242± 124)ml vs.(350± 176)ml,t=-3.365,P=0.001),and the perioperative blood transfusion in the 3D-LPD group was significantly less than that in the 2D-LPD group(x2=4.444,P=0.035).Postoperative hospitalization days and ICU stay time were not significantly different between the two groups(both P>0.05).Postoperative complications such as pancreatic fistula,biliary fistula,postoperative bleeding,gastric emptying disorders,abdominal infection,were not significantly different between the two groups(all P>0.05).Conclusions The operation time of 3D-LPD is shorter than that of 2D-LPD,and the amount of bleeding is less.Short-term clinical data showed that,3D-LPD is effective,safe and worth popularizing.

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作者: 安勇 [1] 张悦 [1] 刘胜勇 [1] 蔡辉华 [1] 陈卫波 [1] 邬迪 [1] 孙冬林 [1] 陈学敏 [1]
第一作者: 安勇
期刊: 《中华外科杂志》2019年57卷5期 353-357页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2019.05.007
发布时间: 2019-06-06
基金项目:
National Natural Science Foundation of China China Post-doctoral Science Foundation(189844)国家自然科学基金 中国博士后科学基金
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