目的:腹腔镜远端胰腺切除术(LDP)和腹腔镜中央胰腺切除术(LCP)是两种可以切除胰颈病变的手术方法。然而,他们的利益仍然存在争议。我们旨在比较LDP和LCP的益处和局限性。
方法:总共,使用我们的数据库对2014年1月至2019年11月期间接受LDP(n=34)或LCP(n=16)的50例患者进行了回顾性分析。我们分析了他们的术前特征,手术数据,病理特征,和术后结果。
结果:两组患者的基线特征无显著差异(P<0.05)。与LDP组相比,LCP组手术时间明显延长(392±144vs.269±130分钟,P=0.007),口服时间(3.8±1.3vs.2.8±0.9天,P=0.017),和住院时间(19.6±5.1vs.15.4±4.1天,P=0.008)以及增加的住院费用(10.1±6.2vs.6.6±1.5万人民币,P=0.023)。然而,转化率无显著差异(0/16vs.0/34),失血量(154±93vs.211±170毫升,P=0.224),术后白细胞计数(10.3±2.7vs.11.1±3.1,P=0.432),术后首次随机血糖水平(8.2±2.1vs.8.6±2.6mmol/L,P=0.696),和术后第3天的腹水淀粉酶水平(5212[3110-14,176]vs.3142[604-13,761]U/L,两组之间P=0.167)。此外,术后糖尿病发生率无显著差异(1/16vs.5/34)两组之间。然而,LCP与B级和C级胰瘘发生率(P=0.005)和术后出血发生率(P=0.031)相关。
结论:与LCP相比,LDP是胰腺颈部良性或低度恶性肿瘤的有用且更安全的技术。
OBJECTIVE: Laparoscopic distal pancreatectomy (LDP) and laparoscopic central pancreatectomy (LCP) are two surgical methods that can remove pancreatic neck lesions. However, their benefits remain controversial. We aimed to compare the benefits and limitations of LDP and LCP.
METHODS: In total, 50 patients who underwent LDP (n = 34) or LCP (n =16) between January 2014 and November 2019 were retrospectively reviewed using our database. We analyzed their preoperative characteristics, operative data, pathological features, and postoperative outcomes.
RESULTS: The baseline features of patients did not differ significantly between the two groups (P < 0.05). Compared with the LDP group, the LCP group showed significantly prolonged operation time (392 ± 144 vs. 269 ± 130 min, P = 0.007), time to oral intake (3.8 ± 1.3 vs. 2.8 ± 0.9 days, P = 0.017), and hospital stay (19.6 ± 5.1 vs. 15.4 ± 4.1 days, P = 0.008) as well as increased hospital expenses (10.1 ± 6.2 vs. 6.6 ± 1.5 WanRMB, P = 0.023). However, no significant differences were observed in conversion rate (0/16 vs. 0/34), blood loss (154 ± 93 vs. 211 ± 170 mL, P = 0.224), postoperative white blood cell count (10.3 ± 2.7 vs. 11.1 ± 3.1, P = 0.432), first random blood glucose level after operation (8.2 ± 2.1 vs. 8.6 ± 2.6 mmol/L, P = 0.696), and ascites amylase level on day 3 after operation (5212 [3110-14,176] vs. 3142 [604-13,761] U/L, P = 0.167) between the two groups. Moreover, no significant differences were noted in the incidence of postoperative diabetes (1/16 vs. 5/34) between the two groups. However, LCP was associated with significantly higher incidences of pancreatic fistula grades B and C (P = 0.005) and postoperative hemorrhage (P = 0.031).
CONCLUSIONS: Compared with the LCP, LDP is a useful and safer technique for benign or low-grade malignant tumors in the pancreatic neck.