摘要
目的:观察胰体尾良性病变行腹腔镜下Kimura法与Warshaw法的治疗效果及安全性.方法:回顾性分析2015年1月至2018年10月于本院接受腹腔镜保脾胰体尾切除术的83例患者临床资料,根据手术方式不同分为Kimura组49例与Warshaw组34例,比较两组围术期指标、手术前后血小板变化、免疫功能变化,记录两组并发症发生情况,并通过随访评价患者远期预后.结果:Kimura组手术时间显著长于Warshaw组(P<0.05),但两组术中出血量、术后排气时间、禁食时间、住院时间及生长抑素应用时间比较差异均无统计学意义(P>0.05);两组术后1周、术后1个月、术后3个月血小板水平与术前比较差异均无统计学意义(P>0.05),且组间同时间点比较差异无统计学意义(P>0.05);Kimura组术后1周、术后1个月CD3+、CD4+、CD4+/CD8+水平与术前比较差异无统计学意义(P>0.05),War-shaw组术后1周CD3+、CD4+水平显著低于术前(P<0.05),术后1月与术前比较差异无统计学意义(P>0.05),但两组同时间点CD3+、CD4+、CD4+/CD8+水平比较差异无统计学意义(P>0.05);Kimura组术后脾梗塞发生率0.00%及并发症总发生率10.20%,均低于Warshaw组的11.76%、29.41%,差异有统计学意义(P<0.05);所有患者随访12~37个月,均未见复发、再次手术病例.结论:腹腔镜下Kimura法与Warshaw法均是保脾胰体尾切除的有效方式,且对患者血小板、免疫功能影响相当,Kimura法虽耗时更长,但可减少并发症发生率,而Warshaw法更适合肿瘤范围大且与脾血管分离困难者.
Objective:To observe the treatment effects and safety of laparoscopic Kimura method and Warshaw method on benign pancreatic body and tail lesions.Methods:Retrospective analysis was performed on clinical data of 83 patients who underwent laparoscopic spleen-preserving distal pancreatectomy in our hospital from January 2015 to October 2018.The patients were divided into Kimura group(49 cases)and Warshaw group(34 cases)according to different surgical methods.The perioperative indexes,and platelet changes and immune function changes before and after surgery were recorded in the two groups.The occurrence of complications were recorded in the two groups,and the long-term prognosis was evaluated with follow-up.Results:The operative time in Kimura group was significantly longer than that in Warshaw group(P<0.05),but there were no significant differences in the intraoperative blood loss,postoperative exhaust time,fasting time,hospital stay and somatostatin application time between the two groups(P>0.05).There was no significant difference in platelet level in the two groups at 1 week,1 month and 3 months after surgery compared with that before surgery(P>0.05),and there was no difference between groups at the same time point(P>0.05).The levels of CD3+,CD4+and CD4+/CD8+in Kimura group at 1 week and 1 month after surgery were not significantly different from those before surgery(P>0.05),and the levels of CD3+and CD4+at 1 week after surgery in Warshaw group were significantly lower than those before surgery(P<0.05),and there were no significant differences at 1 month after surgery compared with those before surgery(P>0.05),but there were no statistically significant differences in the levels of CD3+,CD4+and CD4+/CD8+between the two groups at the same time point(P>0.05).The incidence rate of postoperative splenic infarction and the total incidence rate of complications were 0.00%and 10.20%in Kimura group,which were lower than those in Warshaw group with 11.76%and 29.41%(P<0.05).All patients were followed up for 12 to 37 months.No recurrence or reoperation was found.Conclusion:Both laparoscopic Kimura method and Warshaw method are effective methods for spleen-preserving distal pancreatectomy,and have similar effects on platelet and immune function of patients.Although Kimura method takes longer,it can reduce the incidence rate of complications.Warshaw method is more suitable for those with a large tumor range and difficulty in separating from the spleen blood vessels.
作者
柳凤玲
朱卓立
张代忠
刘洪
刘明忠
LIU Fengling;ZHU Zhuoli;ZHANG Daizhong(Dazhou Central Hospital,Sichuan Dazhou 635000,China)
出处
《河北医学》
CAS
2020年第7期1139-1144,共6页
Hebei Medicine
基金
2018年四川省卫生计生委科技项目立项,(编号:18PJ506)。
关键词
胰体尾占位性病变
腹腔镜
Kimura法
Warshaw法
围术期指标
术后并发症
Pancreatic body and tail space-occupying lesions
Laparoscopy
Kimura method
Warshaw method
Perioperative indexes
Postoperative complications
