Hasselgren K, Halldestam I, Fraser M P, Benjaminsson Nyberg P, Gasslander T, Björnsson B
Departments of Surgery and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Scand J Surg. 2016 Dec;105(4):223-227. doi: 10.1177/1457496915626838. Epub 2016 Jun 23.
BACKGROUND/PURPOSE: Despite retrospective data indicating short-term superiority for laparoscopic distal pancreatectomy compared to open distal pancreatectomy, the implementation of the procedure has been slow. The aim of this study was to investigate whether patients operated with laparoscopic distal pancreatectomy during the early phase of introduction are at higher risk for complications than patients operated with open distal pancreatectomy.
A retrospective single-center analysis of patients operated with laparoscopic distal pancreatectomy (n = 37) from the introduction of the procedure and comparison regarding demographic data, preoperative data, operative factors, and postoperative outcomes to patients operated with open distal pancreatectomy was done.
Operation duration shortened (195 vs 143 min, p = 0.04) and severe complications reduced (37% vs 6%, p = 0.02) significantly in the laparoscopic distal pancreatectomy group between the first half of the study and the second half. Blood loss was significantly (p < 0.001) lower in the laparoscopic distal pancreatectomy group (75 mL) than in the open distal pancreatectomy group (550 mL), while complication rate and hospital stay as well as the percentage of radical resections were the same.
Laparoscopic distal pancreatectomy can be introduced without jeopardizing patient safety and well-being during the early learning curve. The procedures should be compared in a prospective randomized manner.
背景/目的：尽管回顾性数据表明腹腔镜远端胰腺切除术相较于开放远端胰腺切除术具有短期优势，但该手术的实施进展缓慢。本研究的目的是调查在引入该手术的早期阶段接受腹腔镜远端胰腺切除术的患者是否比接受开放远端胰腺切除术的患者发生并发症的风险更高。
对自该手术引入以来接受腹腔镜远端胰腺切除术的患者（n = 37）进行回顾性单中心分析，并将其人口统计学数据、术前数据、手术因素及术后结果与接受开放远端胰腺切除术的患者进行比较。
在研究的前半段与后半段之间，腹腔镜远端胰腺切除术组的手术时间显著缩短（195对143分钟，p = 0.04），严重并发症减少（37%对6%，p = 0.02）。腹腔镜远端胰腺切除术组的失血量（75毫升）显著低于开放远端胰腺切除术组（550毫升）（p < 0.001），而并发症发生率、住院时间以及根治性切除术的比例相同。
在早期学习曲线阶段，引入腹腔镜远端胰腺切除术不会危及患者的安全和健康。应以前瞻性随机方式对这两种手术进行比较。
