腹腔镜胰腺肿瘤剜除术的应用价值
Application value of laparoscopic pancreatic tumor enucleation
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摘要:目的 探讨腹腔镜胰腺肿瘤剜出术（LapEN）的应用价值。方法 采用回顾性描述性研究方法。收集2016年9月至2022年6月河北医科大学第二医院收治的47例行LapEN患者的临床资料；男18例,女29例；年龄为（49±12）岁。观察指标：（1）手术情况。（2）术后并发症情况。（3）术后恢复情况。（4）随访情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M（Q1,Q3）或M（范围）表示,计数资料以绝对数表示。结果 （1）手术情况。47例患者均成功完成LapEN,手术时间为（135±19）min,术中出血量为100（50,100）mL。（2）术后并发症情况。47例患者术后发生胰瘘12例,腹腔感染3例,术后出血和胃排空障碍各1例。（3）术后恢复情况。47例患者中,胰腺实性假乳头状瘤13例,胰岛素瘤12例,胰腺浆液性囊腺瘤11例,胰腺导管内乳头状黏液肿瘤（分支型）7例,胰腺黏液性囊腺瘤4例；肿瘤长径为1.9（1.6,2.3）cm,均为R0切除。47例患者无围手术期死亡病例,术后住院时间为（13±4）d,总住院费用为（6.8±1.2）万元。（4）随访情况。47例患者均获得随访,随访时间为14（8~18）个月。47例患者均无术后新发糖尿病和需外分泌替代治疗的情况,无肿瘤复发病例。结论 对于胰腺良性肿瘤和低度恶性肿瘤,LapEN安全、可行。Abstract:Objective To investigate the application value of laparoscopic pancreatic tumor enucleation (LapEN).Methods The retrospective and descriptive study was conducted. The clinical data of 47 patients who underwent LapEN in Second Hospital of Hebei Medical University from September 2016 to June 2022 were collected. There were 18 males and 29 females, aged (49±12)years. Observa-tion indicators: (1) surgical situations; (2) postoperative complications; (3) postoperative recovery; (4) follow‑up. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(Q1,Q3) or M(range). Count data were described as absolute numbers.Results (1) Surgical situations. All 47 patients underwent LapEN successfully, with the operation time as (135±19)minutes and the volume of intraoperative blood loss as 100(50,100)mL. (2) Postoperative complications. Of the 47 patients, there were 12 patients with postoperative pancreatic fistula, 3 patients with postoperative abdominal infection, 1 case with postoperative hemorrhage, 1 case with postoperative gastric emptying disorder. (3) Postoperative recovery. Of the 47 patients, there were 13 cases with pancreatic solid pseudopapillary neoplasm, 12 cases with insulinoma, 11 cases with pancreatic serous cystadenoma, 7 cases with pancreatic intraductal papillary mucinous neoplasm (branched type), 4 cases with pancreatic mucinous cyst⁃adenoma. The tumor diameter of 47 patients was 1.9(1.6,2.3)cm and all patients with R0 resection. There was no patient with perioperative death in the 47 patients. The postoperative duration of hospital stay and total hospital expenses of 47 patients was (13±4)days and (6.8±1.2) ten thousand yuan, respectively. (4) Follow-up. All 47 patients were followed up for 14(range, 8‒18)months. None of the 47 patients had new onset diabetes or situations required postoperative exocrine replacement therapy, and no patient died.Conclusion LapEN is safe and feasible for patients with pancreatic benign tumor or low potential malignancy.
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