保留脾脏的腹腔镜胰体尾切除术与开腹胰体尾切除术的对照研究

Open vs. laparoscopic spleen-preserving distal pancreatectomy for benign pancreatic lesions

目的对比腹腔镜保留脾脏的胰体尾切除术（laparoscopic spleen-preserving distal pancreatectomy,LSPDP）与开腹保留脾脏的胰体尾切除术（open spleen preserving distal pancreatectomy,OSPDP）的临床疗效。方法回顾性收集2014年1月至2017年8月间胰体尾部良性疾病行手术治疗的临床资料，30例患者行LSPDP手术，20例行OSPDP手术，以术后胰瘘率为主要观察指标。结果LSPDP组与OSPDP组手术时间[（140．33±55．93）min比（182．71±43．51）min]、术中出血量[（175．61±180．78）ml比（253．51±176．06）m1]、术后住院时间[（6．16±7．22）d比（8．85±9．36）d]、术后排气时间[（2．17±1．43）d比（3．10±1．89）d]、术后进食时间[（2．26±1．78）d比（3．42±2．01）d]相比差异存在统计学意义，LSPDP组均优于OSPDP组（均P〈0．05）。LSPDP组与OSPDP组胰瘘率分别为66．7％及70．0％，术后并发症分别为80．0％及90．0％．两者无统计学差异。LSPDP组术后发生胰瘘20例，术后肺部感染2例，腹腔感染1例，乳糜漏1例；OSPDP组患者术后发生胰瘘14例，术后肺部感染2例，腹腔感染2例，均经保守治疗后痊愈。结论LSPDP与OSPDP术后胰瘘率相当。且创伤小．术后恢复快．安全、可行。

Objective To compare the clinical results of laparoscopic spleen-preserving distal pancreatectomy （LSPDP） and open spleen-preserving distal pancreatectomy （OSPDP）. Methods From Jan 2014 to Aug 2017 ,the clinical results of 30 patients undergoing LSPDP were compared with those of 20 OSPDP patients. The postoperative pancreatic fistula rate was the main observation index. Results There was significant difference in operation time [ （ 140. 33± 55.93 ） min vs. （ 182.71 ±43.51 ） min ], blood loss [ （ 175.61± 180. 78 ） ml vs. （253.51 ± 176.06） ml ], postoperative hospital stay [ （ 6. 16 ±7.22 ） d vs. （8.85±9. 36） d ], postoperative exhaust [ （ 2. 17± 1.43 ） d vs. （ 3.10±1.89 ） d ], and postoperative feeding time [ （2. 26 ± 1.78 ） d vs. （ 3.42± 2. 01 ） d ] between LSPDP and OSPDP. LSPDP group was better than OSPDP group （ all P 〈 0. 05 ）. The rate of postoperative pancreatic fistula （ 66. 7% vs. 70. 0% ） and overall complications （80% vs. 90. 0% ） were not statistically different between the two groups. Pancreatic leakage occurred in 20 cases, lung infection in 1 case,peritoneal infection in 1 ease and ehylous leakage in one ease in LSPDP group, while pancreatic leakage in 14 eases, lung infection in 2 eases, and peritoneal infection in 2 eases in OSPDP group, all were cured by conservative therapy. Conehtsions LSPDP is a safe,effective,less traumatic and more economic surgical approach for benign cystic tumors located at the body or tail of the pancreas.