腹腔镜与开腹Kimura法保脾远端胰腺切除术的短期疗效比较

Comparison of short-term efficacy after laparoscopic and open spleen-preserving distal pancreatectomy with Kimura t echnique

目的:通过比较腹腔镜与开腹保留脾血管的远端胰腺切除术(Kimura法)治疗胰腺良性及低度恶性肿瘤的短期疗效,评价腹腔镜行Kimura法保脾远端胰腺切除术的安全性及可行性。方法:回顾分析2015年1月至2021年6月收治的60例行Kimura法保脾远端胰腺切除术患者的临床资料,38例行腹腔镜保脾远端胰腺切除术(LSPDP),22例行开腹保脾远端胰腺切除术(OSPDP),比较两组保脾成功率及短期临床结局。结果:两组患者临床基本特征及病理类型差异无统计学意义(P>0.05);LSPDP组保脾率高于OSPDP组[63.2%(24/38)vs.31.8%(7/22),P=0.019],两组手术时间[(224.60±83.61)min vs.(225.45±88.76)min,P=0.971)]、术中出血量[200(100,725)mL vs.300(200,525)mL,P=0.153]、输血率[23.7%(9/38)vs.31.8%(7/22),P=0.492]、术后并发症发生率[26.3%(10/38)vs.18.2%(4/22),P=0.306]、临床相关术后胰瘘发生率[23.7%(9/38)vs.18.2%(4/22),P=0.236]、住院时间[(16.74±4.65)d vs.(16.91±4.08)d,P=0.886)]、住院费用[(6.67±1.40)万元vs.(7.14±3.11)万元,P=0.498)]差异均无统计学意义。结论:与OSPDP相比,LSPDP并未增加手术时间、术中出血量、术后并发症发生率、住院时间及住院费用,且保脾率更高,是安全、可行的。

Objective:To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy(SPDP)u sing Kimura technique by comparing the short-term efficacy of laparoscopic and open SPDP using Kimura technique for the treatment of benign and low-grade malignant pancreatic tumors.Methods:The clinical data of 60 patients,who underwent SPDP with Kimura technique from Jan.2015 to Jun.2021,were retrospectively analyzed.The 60 patients were divided into laparoscopic spleen-preserving d istal pancreatectomy(LSPDP)group(n=38)and open spleen-preserving distal pancreatectomy(OSPDP)group(n=22)according to the o peration method.The success rate of spleen preservation and short-term postoperative clinical outcomes between the two groups were compared.Results:There was no significant difference in basic clinical characteristics and pathological types between the two groups(P>0.05).The spleen preservation rate of LSPDP group was higher than that of OSPDP group[63.2%(24/38)vs.31.8%(7/22),P=0.019].However,the operation time[(224.60±83.61)min vs.(225.45±88.76)min,P=0.971)],intraoperative blood loss[200(100,725)mL vs.300(200,525)mL,P=0.153],blood transfusion rate[23.7%(9/38)vs.31.8(7/22),P=0.492],postoperative complication incidence[26.3%(10/38)vs.18.2%(4/22),P=0.306],clinically relevant postoperative pancreatic f istula[23.7%(9/38)vs.18.2%(4/22),P=0.236],hospitalization time[(16.74±4.65)d vs.(16.91±4.08)d,P=0.886)],hospitalization cost[(66700±14000)yuan vs.(71400±31100)yuan,P=0.498)]were not significantly different between the two groups.There was no perioperative death in both groups.Conclusions:Compared with OSPDP,LSPDP does not increase the operating time,i ntraoperative blood loss,postoperative complications,hospital stay and hospitalization costs.But LSPDP may be superior to OSPDP in terms of spleen preservation rate.Therefore,LSPDP is safe and feasible.