腹腔镜保留脾脏胰体尾切除术的可行性、安全性及学习曲线研究-现代医学

腹腔镜保留脾脏胰体尾切除术的可行性、安全性及学习曲线研究

单位：湖北医药学院附属随州医院普外科, 湖北随州 441300

分类号：R657.5;R616.5

出版年·卷·期（页码）：2017·36·第三期（328-334）

摘要：

目的： 探讨腹腔镜保留脾脏胰体尾切除术的可行性、安全性及学习曲线。方法：回顾性分析2008年7月至2014年7月本院行腹腔镜胰体尾切除术的97例胰腺良性病变患者临床资料，按照是否保留脾脏分为腹腔镜保留脾脏胰体尾切除术（研究1组）36例和腹腔镜胰体尾联合脾脏切除术（研究2组）61例，比较两组患者手术一般情况、术后并发症；分别于术前及术后1 d、3 d、5 d、1周、1个月、3个月检测两组患者白细胞计数（WBC）、血小板（PLT）、血红蛋白（Hb）、血清C-反应蛋白（CRP）水平。根据腹腔镜保留脾脏胰体尾切除术开展时间分为早期组11例、中期组13例和后期组12例，记录3组手术时间、术中出血量、住院时间及并发症发生率。结果： 研究1组、研究2组手术时间、术中出血量、术后下床活动时间、肛门排气时间、住院时间、拔管时间等手术一般情况比较差异无统计学意义（P>0.05），研究1组、研究2组胰瘘、深静脉血栓、胃静脉曲张、腹腔出血、腹腔积液等并发症发生率比较差异无统计学意义（P>0.05），研究1组感染率显著低于研究2组（P<0.05）。两组术后WBC、CRP均呈上升趋势，至术后3 d达高峰，此后逐渐降低，至术后1个月恢复至术前水平；术后1 d、3 d、5 d、1周研究1组WBC、CPR显著低于研究2组（P<0.05）。早期组、中期组、后期组手术时间、术中出血量、住院时间及并发症发生率均呈降低趋势，后期组手术时间、术中出血量、住院时间显著少于中期组和早期组（P<0.05）；后期组胰瘘、腹腔积液发生率显著低于中期组和早期组（P<0.05）。结论：腹腔镜保留脾脏胰体尾切除手术完全可行，且脾脏保留术后并发症发生率更低；在获得25例左右的手术经验即可进入学习曲线的平台期，有助于术者更好地发挥腹腔镜保留脾脏胰体尾切除术的优势。

Objective: To explore the clinical outcome,safty and learning curve of laparoscopic distal pancreatectomy without splenectomy. Methods:Clinical data of 97 cases of benign pancreatic disease patients who underwent laparoscopic distal pancreatectomy in our hospital from July 2008 to July 2014 were retrospective analysed.According to whether retain the spleen,these patients were divided into laparoscopic distal pancreatectomy without splenectomy group(study 1 group,36 cases) and laparoscopic distal pancreatectomy with splenectomy group(study 2 group, 61 cases). The general operation and postoperative complications were compared between the two groups,the white blood cell count(WBC), platelet(PLT),hemoglobin(Hb) and serum C-reactive protein(CRP) levels were detected before and after operation 1 d, 3 d, 5 d, 1 week, 1 month, 3 month respectively. According to the laparoscopic distal pancreatectomy carried time, these patients were divided into early group(11 cases),middle group(13 cases) and latter group(12 cases),the operation time, blood loss, length of stay and incidence of complications in the three groups were recorded.Results: The operation time, blood loss, postoperative bed time, anal exhaust time, hospitalization time, extubation time and other surgical procedures between study 1 group and study 2 group had no significant difference(P>0.05),the pancreatic fistula, deep vein thrombosis, gastric varices, abdominal bleeding, ascites and other complications between the two groups also had no significant difference(P>0.05),the infection rate in study 1 group was significantly lower than that in the study 2 group(P<0.05).Postoperative CRP, WBC in the two groups showed an upward trend, and reached the peak at 3 d,and then gradually reduced, to 1 months after operation were returned to preoperative values,and WBC,CPR in study 1 group were significantly lower than those in study 2 group at 1 d, 3 d, 5 d, 1 week after operation(P<0.05).The operation time, blood loss, length of stay and incidence of complications were decreased in early group, middle group and latter group. The operation time, the amount of bleeding during operation and the length of hospital stay in latter group were significantly less than those of the middle group and the early group(P<0.05),the incidence of pancreatic fistula and peritoneal effusion in latter group was significantly lower than those in the middle and early stage group(P<0.05). Conclusion: Laparoscopic distal pancreatectomy without splenectomy is completely feasible,and postoperative complications incidence of spleen function preservation is lower. The learning curve platform period is reached after 25 cases of surgical experience, when the dotcor can play the advantage of laparoscopic distal pancreatectomy without splenectomy better.

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