腹腔镜保脾对比切脾的胰体尾切除术治疗胰腺肿瘤:基于倾向性得分匹配的对照研究

Laparoscopic distal pancreatectomy combined with spleen preservation versus splenectomy for pancreatic tumors: a comparative study based on propensity score matching

目的探讨腹腔镜保脾胰体尾切除术治疗胰体尾肿瘤的安全性和有效性。方法回顾性分析宁波市鄞州人民医院肝胆外科于2012年1月至2017年12月行腹腔镜胰体尾切除术的39例患者的临床资料,按照手术方式分为腹腔镜保脾组(n=11)和腹腔镜切脾组(n=28)。经倾向性得分配对后,两组各10例纳入研究,比较两组术中情况及术后近远期并发症情况等。结果保脾组与脾切除组手术时间[(175.3±47.6)min vs (187.6±56.7)min,P=0.15]、切除病灶直径[(31.6±3.7)mm vs (35.8±5.7)mm,P=0.069]差异无统计学意义,但保脾组术中出血量少于切脾组[(45.5±13.4)mL vs (105.9±34.7)mL,P<0.001]。两组术后近期并发症的发生率(80% vs 100%,P=0.531)、胰漏发生率(40% vs 50%,P=0.650)无统计学差异。保脾组术后白细胞(WBC)峰值[(10.6±4.7)×10^9/L vs (15.3±5.9)×10^9/L,P<0.001]以及术后近期血小板(PLT)峰值[(534.0±149.4)×10^12/L vs (718.0±200.9)×10^12/L,P<0.001]低于切脾组,生活质量(QOL)评分[(39.3±8.3) vs (27.0±9.5),P<0.001]优于切脾组。无一例发生爆发性感染。结论腹腔镜保脾胰体尾切除术和腹腔镜切脾胰体尾切除术具有相同的安全性和可行性,腹腔镜保脾胰体尾切除术后患者生活质量更高,血液稳定性更佳。

Objective To investigate the safety and efficacy of laparoscopic spleen-preserving distal pancreatectomy(LSPDP) for pancreatic tumors. Methods Clinical data of 39 cases who underwent laparoscopic distal pancreatectomy in Yinzhou People’s Hospital from Jan. 2012 to Dec. 2017 were analyzed retrospectively. Patients were divided into LSPDP group(11 cases) and laparoscopic distal pancreatectomy combined with splenectomy group(LDP group, 28 cases). After 1:1 propensity score matching, 10 cases in each group were included in the study. The intraoperative condition, short-and long-term complication incidence after surgery between two groups were compared. Results There were no significant differences in operation time [LSPDP group:(175.3±47.6)min vs LDP group:(187.6±56.7)min, P=0.15] or the size of resected tumor [LSPDP group:(31.6±3.7)mm vs LDP group:(35.8±5.7)mm, P=0.069] between the two groups. The blood loss in LSPDP group was less than that in LDP group [(45.5±13.4)mL vs(105.9±34.7)mL, P<0.001]. There was no statistical difference in short-term postoperative complication incidence rates(80% vs 100%, P=0.531), and pancreatic fistula incidence rates(40% vs 50%, P=0.650). Hematologic stability in LSPDP group were better than those in LDP group [WBC:(10.6±4.7)×10^9/L vs(15.3±5.9)×10^9/L, P<0.001 and PLt(534.0±149.4)×10^12/L vs(718.0±200.9)×10^12/L,P<0.001]. And QOL score in LSPDP group was higher than that in combined group [(39.3±8.3) vs(27.0±9.5), P<0.001]. There was no post-splenectomy infection case in any group. Conclusion LSPDP for pancreatic tumors is as safe as pancreatectomy combined with splenectomy, which is associated with better blood stability and quality of life.