Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China.
School of Medicine, Zhejiang University, Hangzhou, 310029, Zhejiang Province, China.
Surg Endosc. 2017 Nov;31(11):4756-4763. doi: 10.1007/s00464-017-5552-7. Epub 2017 Apr 19.
The studies comparing laparoscopic and open central pancreatectomy with pancreaticojejunostomy are limited. This study aimed to compare clinical outcomes and quality of life of patients undergoing laparoscopic and open central pancreatectomy with pancreaticojejunostomy.
Between December 1997 and December 2015, patients who underwent central pancreatectomy with pancreaticojejunostomy were reviewed. Patients were divided into 2 groups as laparoscopic central pancreatectomy (LCP) and open central pancreatectomy (OCP). Data considered for comparison analysis were patient demographics, intraoperative variables, morbidity, postoperative hospital stay, mortality, pathologic findings, and quality of life (SF-36 questionnaire).
Thirty-six patients (17 LCP and 19 OCP) were included in the final analysis. Baseline characteristics were similar in the 2 groups. The operating time (280.4 ± 33.6 vs. 290.5 ± 62.5 min, p = 0.455) were similar between two groups. LCP group showed significantly lower estimated blood loss (76.4 ± 70.3 vs. 390.3 ± 279.0 ml, p = 0.001), shorter first flatus time (2.4 ± 0.9 vs. 3.9 ± 1.3 days, p = 0.001), and shorter diet start time (4.1 ± 2.2 vs. 6.1 ± 2.4 days, p = 0.030). However, the postoperative hospital stay was not significantly different between two groups (15.6 ± 12.1 vs. 24.0 ± 27.5 days, p = 0.347). Postoperative outcomes, including morbidity (58.8 vs. 52.6%, p = 0.749), pancreatic fistula rates (≥grade B: 17.6 vs. 36.8%, p = 0.106), and mortality, were similar in the 2 groups. The median follow-up period was 45 months (range 4-216 months). No local recurrence or distant metastasis was detected in either group. On the follow-up survey, the total quality of life score (702.9 ± 47.9 vs. 671.8 ± 94.1), physical health score (353.9 ± 24.8 vs. 326.6 ± 67.6) and mental health score (349.0 ± 26.5 vs. 345.2 ± 34.6) were higher in the LCP group compared with the OCP group. However, these differences were not statistically significant (p > 0.05). The score in role physical (100 vs. 73.1 ± 4.8, p = 0.042) was significantly higher in LCP group, and not statistically significant in other areas (p > 0.05).
LCP with pancreaticojejunostomy is safe and feasible for benign or borderline malignant lesions in the pancreatic neck and proximal body. Compared to OCP, LCP is associated with lower estimated blood loss, faster recovery, and better quality of life.
比较腹腔镜和开腹胰体尾切除术联合胰肠吻合术的研究有限。本研究旨在比较腹腔镜和开腹胰体尾切除术联合胰肠吻合术患者的临床结局和生活质量。
回顾 1997 年 12 月至 2015 年 12 月间接受胰体尾切除术联合胰肠吻合术的患者。患者分为腹腔镜胰体尾切除术（LCP）和开腹胰体尾切除术（OCP）两组。比较分析的数据包括患者人口统计学资料、术中变量、发病率、术后住院时间、死亡率、病理发现和生活质量（SF-36 问卷）。
最终纳入 36 例患者（17 例 LCP 和 19 例 OCP）进行最终分析。两组患者的基线特征相似。两组的手术时间（280.4±33.6 分钟 vs. 290.5±62.5 分钟，p=0.455）相似。LCP 组的估计出血量（76.4±70.3 毫升 vs. 390.3±279.0 毫升，p=0.001）、首次排气时间（2.4±0.9 天 vs. 3.9±1.3 天，p=0.001）和开始进食时间（4.1±2.2 天 vs. 6.1±2.4 天，p=0.030）均明显较低。然而，两组的术后住院时间无显著差异（15.6±12.1 天 vs. 24.0±27.5 天，p=0.347）。术后并发症发生率（58.8% vs. 52.6%，p=0.749）、胰瘘发生率（≥grade B：17.6% vs. 36.8%，p=0.106）和死亡率在两组间相似。中位随访时间为 45 个月（范围 4-216 个月）。两组均未发现局部复发或远处转移。在随访调查中，LCP 组的总生活质量评分（702.9±47.9 分 vs. 671.8±94.1 分）、生理健康评分（353.9±24.8 分 vs. 326.6±67.6 分）和心理健康评分（349.0±26.5 分 vs. 345.2±34.6 分）均高于 OCP 组。然而，这些差异无统计学意义（p>0.05）。LCP 组的角色身体评分（100 分 vs. 73.1±4.8 分，p=0.042）明显更高，而其他领域的评分则无统计学意义（p>0.05）。
对于胰腺颈部和体部的良性或交界性病变，LCP 联合胰肠吻合术是安全可行的。与 OCP 相比，LCP 具有较低的估计出血量、更快的恢复和更好的生活质量。
