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首页> 美国卫生研究院文献>Thieme Open Access >Perioperative and Long-term Oncological Results of Minimally Invasive Pancreatoduodenectomy as Hybrid Technique – A Matched Pair Analysis of 120 Cases
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Perioperative and Long-term Oncological Results of Minimally Invasive Pancreatoduodenectomy as Hybrid Technique – A Matched Pair Analysis of 120 Cases

机译：微创胰十二指肠切除术的围手术期和长期肿瘤学结果-混合配对分析120例

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>Background Laparoscopic pancreatoduodenectomy is a highly challenging procedure. The aim of this study was to analyse post-operative morbidity and mortality as well as long term overall survival in patients undergoing hybrid LPD, as compared to open pancreaticoduodenecomy (OPD) in a single surgeon series. >Methods Patients undergoing pancreatoduodenectomy (PD) in the period from 2000 to 2015 were identified from a prospectively maintained database. All LPD procedures were performed by one specialised pancreatic surgeon (TK). Patients were matched 1 : 1 for age, sex, BMI, ASA, histological diagnosis, pancreatic texture and portal venous resection (PVR). All LPD procedures were performed as hybrid LPD – combining laparoscopic resection and open reconstruction via mini laparotomy. >Results A total of 549 patients were identified, including 489 patients in the OPD group and 60 patients in the LPD group. 60 patients were identified who underwent LPD between 2010 and 2015 versus 60 OPD patients operated in the same period. Median overall operation time was shorter in the LPD group than with OPD patients (LPD 352 vs. OPD 397 min; p = 0.002). Overall transfusion units were lower in the LPD group (LPD range 0 – 4 vs. OPD range 0 – 11; p = 0.032). Intensive care unit stay (LPD 1 vs. OPD 6 d; p = 0.008) and overall hospital stay (OHS: LPD 14 vs. OPD 18 d; p = 0.012) were shorter in the LPD groups than in the OPD group. As regards postoperative complications, LPD was associated with reduced rates of clinically relevant grade B/C postoperative pancreatic fistula (LPD 15 vs. OPD 36%; p = 0.036) and grade B/C delayed gastric emptying (LPD 8 vs. OPD 20%; p = 0.049). A total of 56 patients were diagnosed with malignant disease. The number of harvested lymph nodes and R0-resection rates were equal for LPD and OPD patients. LPD patients showed a trend to improved median overall survival (LPD mean 56 months vs. OPD mean 48 months; p = 0.056). >Conclusion Hybrid LPD is a safe procedure associated with a reduction in clinically relevant postoperative complications and allows faster recovery. Long term oncological outcome of hybrid LPD for malignant disease is equal to that with the standard open approach.
机译：>背景腹腔镜胰十二指肠切除术是一项极富挑战性的手术。这项研究的目的是分析与单一外科医师系列开放性胰十二指肠切除术（OPD）相比，接受混合LPD的患者的术后发病率和死亡率以及长期总体生存率。 >方法从前瞻性维护的数据库中识别出2000年至2015年期间接受胰十二指肠切除术（PD）的患者。所有LPD程序均由一名专门的胰腺外科医生（TK）执行。患者的年龄，性别，BMI，ASA，组织学诊断，胰脏质地和门静脉切除术（PVR）匹配程度为1：1。所有LPD程序均作为混合LPD进行–结合腹腔镜切除和通过小型剖腹手术进行开放重建。 >结果共鉴定出549例患者，其中OPD组489例，LPD组60例。在2010年至2015年期间，确定了60例接受LPD的患者，而同期进行手术的60例OPD患者。 LPD组的中位总体手术时间短于OPD患者（LPD 352 vs. OPD 397分钟； p = 0.002）。 LPD组的总体输血单位较低（LPD范围为0 – 4对比OPD范围为0 – 11； p = 0.032）。 LPD组的重症监护病房住院时间（LPD 1 vs. OPD 6 d； p = 0.008）和整体住院时间（OHS：LPD 14 vs. OPD 18 d； p = 0.012）比OPD组短。关于术后并发症，LPD与临床相关的B / C级胰瘘术后发生率降低（LPD 15 vs. OPD 36％； p = 0.036）和B / C级胃排空延迟（LPD 8 vs. OPD 20％）相关。 ； p = 0.049）。共有56名患者被诊断为恶性疾病。 LPD和OPD患者的淋巴结数目和R0切除率相等。 LPD患者表现出总体中位生存改善的趋势（LPD平均56个月，OPD平均48个月； p; = 0.056）。 >结论混合LPD是一种安全的方法，可减少与临床相关的术后并发症，并可以更快地恢复。混合型LPD对恶性疾病的长期肿瘤学结果与标准开放方法相同。

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