Nakamura Yoshiharu, Matsushita Akira, Katsuno Akira, Sumiyoshi Hiroki, Yoshioka Masato, Shimizu Tetsuya, Mizuguchi Yoshiaki, Uchida Eiji
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
Asian J Endosc Surg. 2014 Nov;7(4):295-300. doi: 10.1111/ases.12131. Epub 2014 Oct 9.
Laparoscopic distal pancreatectomy (Lap-DP) has been recognized worldwide as a feasible and highly beneficial procedure. The aim of this study is to investigate whether Lap-DP techniques are being implemented safely by surgeons training to perform this procedure.
We retrospectively compared the perioperative outcomes of Lap-DP in patients operated on by the surgeon originating this procedure at our hospital (expert surgeon group [E group], n = 47) and patients operated on by surgeons training to perform this procedure (training surgeons group [T group], n = 53).
The median operating times for the E group and T group were 321 min (range, 150-653 min) and 314 min (range, 173-629 min), respectively; these times were not significantly different (P = 0.4769). The median blood loss in the T group (100 mL; range, 0-1950 mL) was significantly smaller than in the E group (280 mL; range, 0-1920 mL) (P = 0.0003). There were no significant intergroup differences in other operative results: combined operation ratio, spleen- and splenic vessels-preserving ratio, hand-assisted procedure ratio, and the ratio of transition to open. The frequency of pancreatic fistulas in the E group and T group was 12.8% and 16.9%, respectively; these rates were not significantly different (P = 0.5886). There were no significant differences between the two groups in terms of other complications and reoperation rates. The median hospital stay for the E group was significantly shorter than for the T group (10 vs 13 days; P = 0.0307).
This retrospective analysis shows that teaching safe Lap-DP techniques to surgeons is reflected in stable perioperative outcomes.
腹腔镜远端胰腺切除术（Lap-DP）在全球范围内已被公认为是一种可行且极具益处的手术。本研究的目的是调查接受该手术培训的外科医生是否能安全地实施Lap-DP技术。
我们回顾性比较了在我院开展该手术的外科医生（专家外科医生组[E组]，n = 47）和接受该手术培训的外科医生（培训外科医生组[T组]，n = 53）所实施的Lap-DP患者的围手术期结果。
E组和T组的中位手术时间分别为321分钟（范围150 - 653分钟）和314分钟（范围173 - 629分钟）；这些时间无显著差异（P = 0.4769）。T组的中位失血量（100毫升；范围0 - 1950毫升）显著低于E组（280毫升；范围0 - 1920毫升）（P = 0.0003）。其他手术结果在组间无显著差异：联合手术率、保留脾脏和脾血管率、手辅助手术率以及转为开放手术的比例。E组和T组胰瘘的发生率分别为12.8%和16.9%；这些发生率无显著差异（P = 0.5886）。两组在其他并发症和再次手术率方面无显著差异。E组的中位住院时间显著短于T组（10天对13天；P = 0.0307）。
这项回顾性分析表明，向外科医生传授安全的Lap-DP技术体现在稳定的围手术期结果中。
