Sahakyan Mushegh A, Røsok Bård Ingvald, Kazaryan Airazat M, Barkhatov Leonid, Haugvik Sven-Petter, Fretland Åsmund Avdem, Ignjatovic Dejan, Labori Knut Jørgen, Edwin Bjørn
The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.
Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
Surg Endosc. 2017 May;31(5):2310-2316. doi: 10.1007/s00464-016-5233-y. Epub 2016 Sep 12.
Previous studies report successful application of laparoscopic pancreatic enucleation (LPE). However, the evidence is limited to small series. This study aimed to evaluate the indications, technique and outcome of LPE at a tertiary care institution.
Between February 1998 and April 2016, 45 consecutive LPEs were performed at Oslo University Hospital-Rikshospitalet. Twenty-four (53.3 %) patients subjected to right-sided LPE (RLPE) were compared with 21 (46.7 %) patients who had undergone left-sided LPE (LLPE). A case-matched analysis (1:2) was performed to compare the outcomes following LLPE and laparoscopic distal pancreatectomy (LDP).
Patient demographics, BMI, ASA score and pathological characteristics were similar between the RLPE and LLPE groups. Operative time was slightly longer for RLPE [123 (53-320) vs 102 (50-373) min, P = 0.09]. The rates of severe morbidity (≥Accordion grade III) and clinically relevant pancreatic fistula (grades B/C) were comparable, although with a trend for higher rate of complications following LLPE (16.7 vs 33.3 %; P = 0.19 and 20.8 vs 33.3 %, P = 0.34, respectively). The hospital stay was similar between RLPE and LLPE [5 (2-80) vs 7 (2-52), P = 0.49]. A case-matched analysis demonstrated shorter operating time [145 (90-350) vs 103 (50-233) min, P = 0.02], but higher readmission rate following LLPE (25 vs 3.1 %, P = 0.037).
LLPE seems to be associated with a higher risk of postoperative morbidity and readmission rates than LDP. RLPE is a feasible, safe approach and a reasonable alternative to pancreatoduodenectomy in selected patients with pancreatic lesions.
既往研究报道了腹腔镜胰腺摘除术（LPE）的成功应用。然而，证据仅限于小样本系列研究。本研究旨在评估一家三级医疗机构中LPE的适应证、技术及结果。
1998年2月至2016年4月期间，奥斯陆大学医院国立医院连续进行了45例LPE。将24例（53.3%）接受右侧LPE（RLPE）的患者与21例（46.7%）接受左侧LPE（LLPE）的患者进行比较。进行病例匹配分析（1:2）以比较LLPE与腹腔镜远端胰腺切除术（LDP）后的结果。
RLPE组和LLPE组患者的人口统计学特征、BMI、ASA评分及病理特征相似。RLPE的手术时间稍长[123（53 - 320）分钟 vs 102（50 - 373）分钟，P = 0.09]。严重并发症（≥Accordion III级）和临床相关胰瘘（B/C级）的发生率相当，尽管LLPE后并发症发生率有升高趋势（分别为16.7% vs 33.3%；P = 0.19和20.8% vs 33.3%，P = 0.34）。RLPE和LLPE的住院时间相似[5（2 - 80）天 vs 7（2 - 52）天，P = 0.49]。病例匹配分析显示LLPE的手术时间较短[145（90 - 350）分钟 vs 103（50 - 233）分钟，P = 0.02]，但LLPE后的再入院率较高（25% vs 3.1%，P = 0.037）。
与LDP相比，LLPE术后发病风险和再入院率似乎更高。RLPE是一种可行、安全的方法，对于选定的胰腺病变患者是胰十二指肠切除术的合理替代方案。
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