保留十二指肠的胰头切除术在胰头部良性病变中的应用及对术后生活质量的影响研究
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摘要
目的探讨保留十二指肠的胰头切除术在胰头部良性病变中的应用效果及对患者术后生活质量的影响。方法选自2015年1月至2016年12月接受治疗的胰头部良性病变患者20例,对其实施保留十二指肠的胰头切除术,回顾性分析其临床相关资料,采用SPSS 20软件对患者的体重、VAS评分、生活质量功能量表评分等进行统计学分析,以P<0.05认为具有统计学意义。结果所有患者均顺利完成手术,手术时间为(3.6~5.4)h,平均时间为(4.52±0.37)h;术后住院(10~23)d,平均时间为(12.13±0.29)d;患者无术后出血、腹腔脓肿、胰腺假性囊肿等并发症发生,恢复顺利,无十二指肠梗阻现象、无血糖异常情况发生。术后共发生胰瘘1例、逆行性胆道感染1例,并发症发生率为10.00%(2/20)。术后患者的VAS评分(3.18±0.89)分明显优于术前(7.48±1.86)分,术后患者的躯体功能(89.96±2.58)分、情绪功能(89.99±3.17)分、角色功能(91.05±3.13)分等评分明显高于术前评分,差异均有统计学意义(P<0.05)。结论保留十二指肠的胰头切除术可有效提高胰头部良性病变患者的生活质量,临床应用效果较优。
Objective To study the clincal effect of duodenal-preserving pancreatic head resection in treating benign lesions of the pancreatic head. Methods From January 2015 to December 2016,clinical data of 20 patients with benign lesions of pancreatic head were analyzed retrospectively,who received duodenal-preserving pancreatic head resection. Statistical analysis were performed by using SPSS 20. 0 software,including patients' weight,VAS score and quality of life function scale. A P value of < 0. 05 was considered as statistically significant. Results All patients received successful operation,with average time of 4. 52 ± 0. 37 h(3. 6 ~ 5. 4 h),the average hospitalization time of 12. 13 ± 0. 29 d(10 ~ 23 d). There were no postoperative complications such as bleeding,abdominal abscess or pancreatic pseudocyst. No duodenal obstruction occurred and no abnormal blood sugar occurred. There were 1 case of pancreatic fistula and 1 case of retrograde biliary tract infection. The complication rate was 10. 00%(2/20). The VAS score of patients after operation(3. 18 ± 0. 89) were significantly better than(7. 48 ± 1. 86) before surgery. Physical function of(89. 96 ± 2. 58),emotional function of(89. 99 ± 3. 17) and role function of(91. 05 ± 3. 13) of patients after surgery were significantly higher than preoperative score,with significant difference(P < 0. 05).Conclusion Duodenal-preserving pancreatic head resection could effectively improve the quality of life in patients with benign lesions of the head of pancreas,and the clinical application effect is better.
Objective To study the clincal effect of duodenal-preserving pancreatic head resection in treating benign lesions of the pancreatic head. Methods From January 2015 to December 2016,clinical data of 20 patients with benign lesions of pancreatic head were analyzed retrospectively,who received duodenal-preserving pancreatic head resection. Statistical analysis were performed by using SPSS 20. 0 software,including patients' weight,VAS score and quality of life function scale. A P value of < 0. 05 was considered as statistically significant. Results All patients received successful operation,with average time of 4. 52 ± 0. 37 h(3. 6 ~ 5. 4 h),the average hospitalization time of 12. 13 ± 0. 29 d(10 ~ 23 d). There were no postoperative complications such as bleeding,abdominal abscess or pancreatic pseudocyst. No duodenal obstruction occurred and no abnormal blood sugar occurred. There were 1 case of pancreatic fistula and 1 case of retrograde biliary tract infection. The complication rate was 10. 00%(2/20). The VAS score of patients after operation(3. 18 ± 0. 89) were significantly better than(7. 48 ± 1. 86) before surgery. Physical function of(89. 96 ± 2. 58),emotional function of(89. 99 ± 3. 17) and role function of(91. 05 ± 3. 13) of patients after surgery were significantly higher than preoperative score,with significant difference(P < 0. 05).Conclusion Duodenal-preserving pancreatic head resection could effectively improve the quality of life in patients with benign lesions of the head of pancreas,and the clinical application effect is better.
引文
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[4]张航,王敏,秦仁义.3D腹腔镜胰十二指肠切除术的临床疗效[J].中华消化外科杂志,2016,15(9):907-912.
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[9]聂鲁愚,包善华,卢成林,等.中段胰切除术在胰腺体部良性病变中的应用[J].实用临床医药杂志,2016,20(9):120-121.
[10]陈志国,曹大勇,岳树强.保留十二指肠胰头切除术九例临床分析[J].临床外科杂志,2013,21(4):264-266.
[11]Glazer ES,Amini A,Jie T,et al.Recognition of complications after pancreaticduodenectomy for cancer determines in patient mortality[J].JOP,2013,14(6):626-631.
[12]吴祥虎,朱峰,王敏,等.腹腔镜胰十二指肠切除术的安全性和有效性研究[J].中华腔镜外科杂志(电子版),2015,8(1):8-11.
[13]谢彬,王槐志.保留十二指肠胰头切除术的手术要点及适应证把握[J].肝胆外科杂志,2014,22(1):5-7.
[14]王志东,姜兴明,钟翔宇,等.联合应用多种动脉优先人路胰十二指肠切除术的经验总结[J].中华外科杂志,2016,54(11):854-858.
[15]罗天平,秦锡虎,柳咏,等.保留十二指肠、胆管的胰头切除术治疗胰头良性病变[J].中华普通外科杂志,2015,30(1):54-55.
[2]王科伟,李昱骥,董明,等.保留十二指肠的胰头切除术治疗胰头部良性病变14例分析[J].中国普外基础与临床杂志,2014,21(12):1548-1551.
[3]王渊全,李建国,叶剑鹏.改良Takada法保留十二指肠的胰头全切除[J].中华普通外科杂志,2016,31(5):382-386.
[4]张航,王敏,秦仁义.3D腹腔镜胰十二指肠切除术的临床疗效[J].中华消化外科杂志,2016,15(9):907-912.
[5]Beger HG,Schwarz M,Poeh B.Duodenm-preserving total pancreatic head resection for benign cystic neoplastic lesions[J].J Gastrointest Surg,2012,16(11):2160-2166.
[6]蒋康怡,吴柯,廖玉平,等.保留十二指肠的胰头切除术与胰十二指肠切除术治疗胰头肿块型胰腺炎的Meta分析[J].中华外科杂志,2014,52(9):668-674.
[7]张太平,申鹏,赵玉沛.不断提高胰腺癌诊治规范化水平[J].中华普外科手术学杂志(电子版),2015,9(4):231-234.
[8]Bachmann K,Tomkoetter L,Kutup A,et a1.Is the Whipple procedure harmful for long-term outcome in treatment of chronic pancreatitis?15-years follow-up comparing the outcome after pylorus-preserving pancreatoduodenectomy and Frey procedure in chronic pancreatitis[J].Ann Surg,2013,258(5):815-821.
[9]聂鲁愚,包善华,卢成林,等.中段胰切除术在胰腺体部良性病变中的应用[J].实用临床医药杂志,2016,20(9):120-121.
[10]陈志国,曹大勇,岳树强.保留十二指肠胰头切除术九例临床分析[J].临床外科杂志,2013,21(4):264-266.
[11]Glazer ES,Amini A,Jie T,et al.Recognition of complications after pancreaticduodenectomy for cancer determines in patient mortality[J].JOP,2013,14(6):626-631.
[12]吴祥虎,朱峰,王敏,等.腹腔镜胰十二指肠切除术的安全性和有效性研究[J].中华腔镜外科杂志(电子版),2015,8(1):8-11.
[13]谢彬,王槐志.保留十二指肠胰头切除术的手术要点及适应证把握[J].肝胆外科杂志,2014,22(1):5-7.
[14]王志东,姜兴明,钟翔宇,等.联合应用多种动脉优先人路胰十二指肠切除术的经验总结[J].中华外科杂志,2016,54(11):854-858.
[15]罗天平,秦锡虎,柳咏,等.保留十二指肠、胆管的胰头切除术治疗胰头良性病变[J].中华普通外科杂志,2015,30(1):54-55.