腹腔镜与开腹胰十二指肠切除术治疗胰头癌的疗效对比及术后肿瘤早期复发的随访研究

摘要 目的：对比腹腔镜与开腹胰十二指肠切除术治疗胰头癌的疗效，并分析术后肿瘤早期复发的影响因素。方法：选择2019年3月~2020年4月期间四川大学华西空港医院普外科收治的15例及四川大学华西医院胰腺外科收治的65例共计80例胰头癌患者，根据手术方式的不同分为开腹组和微创组，例数分别为32例和48例，对比两组围术期相关临床指标、并发症发生率和随访期间的肿瘤早期复发率。采用多因素Logistic回归分析术后早期复发的影响因素。结果：微创组的手术时间长于开腹组，住院费用多于开腹组，术中出血量少于开腹组，下床活动时间、术后排气时间、开始进食时间、术后住院时间短于开腹组（P<0.05）。两组并发症发生率对比无差异（P>0.05）。两组术后肿瘤早期复发率对比差异无统计学意义（P>0.05）。单因素分析结果显示，胰头癌患者术后肿瘤早期复发与年龄、肿瘤最大直径、有无淋巴结转移、有无脉管癌栓、有无神经侵犯、术前白蛋白、术前糖类抗原125（CA125）、术前癌胚抗原（CEA）水平、术后有无放化疗有关（P<0.05）。多因素Logistic回归分析显示：淋巴结转移、脉管癌栓、神经侵犯、术后未放化疗以及术前CA125水平较高是胰头癌患者术后肿瘤早期复发的危险因素（P<0.05）。结论：相较于传统开腹手术，腹腔镜下行胰十二指肠切除术治疗胰头癌，可缩短住院时间，促进患者术后恢复，但两者间并发症发生率和术后早期复发率无显著差异。胰头癌术后肿瘤早期复发受到淋巴结转移、脉管癌栓、神经侵犯、术后放化疗、术前CA125水平等多种因素的影响。

Comparison of Laparoscopic and Open Pancreaticoduodenectomy in the Treatment of Pancreatic Head Cancer and Follow-Up Study of Early Postoperative Tumor Recurrence

ABSTRACT Objective: To compare the efficacy of laparoscopic and open pancreaticoduodenectomy in the treatment of pancreatic head cancer, and to analyze the influencing factors of early postoperative tumor recurrence. Methods: A total of 80 patients with pancreatic head cancer were selected from 15 patients admitted to the General Surgery Department of West China Airport Hospital of Sichuan University and 65 patients admitted to the Pancreatic Surgery Department of West China Hospital of Sichuan University from March 2019 to April 2020. They were divided into open group and minimally invasive group according to different operation methods, with 32 cases and 48 cases respectively. The perioperative related clinical indexes, the incidence of complications and the early recurrence rate of tumor during follow-up were compared between the two groups. Multivariate Logistic regression was used to analyze the influencing factors of early postoperative recurrence. Results: The operation time of minimally invasive group was longer than that of open group, the hospitalization cost was more than that of open group, the amount of intraoperative bleeding was less than that of open group, the out of bed activity time, postoperative exhaust time, start eating time, postoperative hospital stay were shorter than those of open group (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). There was no significant difference in the early recurrence rate between the two groups(P>0.05). Univariate analysis showed that the early recurrence of patients with pancreatic head cancer was related to age, maximum tumor diameter, with or without lymph node metastasis, with or without vascular tumor thrombus, with or without nerve invasion, preoperative albumin, preoperative carbohydrate antigen 125 (CA125), preoperative carcinoembryonic antigen (CEA) levels, and with or without postoperative radiotherapy and chemotherapy (P<0.05). Multivariate Logistic regression analysis showed that lymph node metastasis, vascular tumor thrombus, nerve invasion, without postoperative radiotherapy and chemotherapy and high preoperative CA125 level were the risk factors for early postoperative recurrence of pancreatic head cancer (P<0.05). Conclusion: Compared with traditional open surgery, laparoscopic pancreaticoduodenectomy for pancreatic head cancer can shorten the hospitalization time and promote the postoperative recovery of patients, but there is no significant difference in the incidence of complications and early postoperative recurrence between the two. The early recurrence of pancreatic head cancer after operation is affected by many factors, such as lymph node metastasis, vascular tumor thrombus, nerve invasion, postoperative radiotherapy and chemotherapy, preoperative CA125 level and so on.