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目的:比较腹腔镜胰十二指肠切除术合并扩大淋巴结清扫与开腹手术的临床疗效。方法 :回顾性分析我院2014年7月至2016年7月185例胰十二指肠切除术病人中160例病人的临床资料。按手术方式分为腔镜组和开腹组,其中腔镜组84例,开腹组76例。比较两组病人在术后胰漏、胆漏、出血、胃排空障碍的发生率以及淋巴结清扫数、手术时间和住院时间。结果:腔镜组与开腹组相比,年龄、性别、主要合并症等差异无统计学意义(P>0.05)。术后胆漏、胃排空障碍、出血、腹泻发生率以及手术时间、住院时间和下床时间均无统计学差异。腔镜组淋巴结清扫数较多,胰漏尤其是B级和C级胰漏发生率以及总并发症发生率明显下降(P<0.05)。结论:腹腔镜胰十二指肠切除术中扩大淋巴结清扫,可清除更多淋巴结,并降低胰漏发生率和术后总并发症发生率,有利于肿瘤病理分期,有利于延缓肿瘤复发。
Objective: To compare the clinical efficacy of laparoscopic pancreatoduodenectomy combined with extended lymph node dissection and laparotomy. Methods: A retrospective analysis of our hospital from July 2014 to July 2016 in 185 cases of pancreatoduodenectomy in patients with clinical data of 160 patients. According to the operation mode, they were divided into laparoscopic group and open group, including 84 cases of endoscopic group and 76 cases of open group. The incidence of postoperative pancreatic leakage, bile leakage, bleeding, gastric emptying disorder, number of lymph node dissection, operation time and hospital stay were compared between the two groups. Results: There was no significant difference in age, sex, major comorbidity between endoscopic group and open group (P> 0.05). Postoperative bile leakage, gastric emptying disorders, bleeding, the incidence of diarrhea and surgery time, hospital stay and bed time were not statistically different. There were more lymph node dissection in the endoscopic group, and the incidence of pancreatic leakage, especially grade B and C pancreases, and the overall complication rate decreased significantly (P <0.05). Conclusions: Expanding lymph node dissection during laparoscopic pancreatoduodenectomy can clear more lymph nodes and reduce the incidence of pancreatic leakage and the incidence of postoperative complications. It is helpful for the staging of tumor and is helpful to delay the tumor recurrence.