Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Prof. Minni, Alma Mater Studiorum, Università di Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy.
Surg Endosc. 2018 Sep;32(9):3839-3845. doi: 10.1007/s00464-018-6113-4. Epub 2018 Feb 12.
Laparoscopic distal pancreatectomy represents a difficult surgical procedure with an high conversion rate to open procedure. The factors related to its difficulty and conversion to open distal pancreatectomy were rarely reported. The aim of the present study was to identify which factors are related to conversion from laparoscopic to open distal pancreatectomy.
A retrospective study of a prospective database of 68 patients who underwent laparoscopic distal pancreatectomy was conducted at a high-volume center by pancreatic surgeons experienced with laparoscopic surgery. Pre-intra and postoperative data were collected. Patients who completed a laparoscopic distal pancreatectomy were compared with those who needed a conversion to the open approach as regard demographic, clinical, radiological, and surgical data. Univariate and multivariate analyses were carried out.
Univariate analysis suggested that the site of the lesion, the extension of pancreatic resection, and the requirement for an extended procedure to adjacent organs were significantly associated with the risk of conversion to the open approach. Multivariate analysis showed that only the extension of the pancreatic resection (subtotal pancreatectomy) was significantly related to the odds of conversion [odds ratio (OR) 19.5; 95% confidence interval (CI) 1.1-32.3; P = 0.038]. Preoperative suspicion of malignancy differed between the two groups; however, this difference did not reach statistical significance (P = 0.078).
Despite the limitations of the study, only the extension of pancreatic resection seemed to be the main factor related to conversion during laparoscopic distal pancreatectomy.
腹腔镜胰体尾切除术是一种具有较高中转开腹率的复杂手术。目前，很少有研究报道与该手术难度及中转开腹相关的因素。本研究旨在明确哪些因素与腹腔镜胰体尾切除术中转开腹相关。
对胰腺外科医生在高容量中心进行的一项前瞻性数据库中 68 例腹腔镜胰体尾切除术患者进行回顾性研究。收集术前、术中及术后资料。比较完成腹腔镜胰体尾切除术的患者与需要中转开腹的患者在人口统计学、临床、影像学和手术方面的数据。进行单因素和多因素分析。
单因素分析提示病变部位、胰腺切除范围以及是否需要向邻近器官扩展手术与中转开腹风险显著相关。多因素分析显示，仅胰腺切除范围（次全胰切除术）与中转开腹的几率显著相关[比值比（OR）19.5；95%置信区间（CI）1.1-32.3；P = 0.038]。两组患者术前对恶性肿瘤的怀疑不同，但差异无统计学意义（P = 0.078）。
尽管存在研究局限性，但只有胰腺切除范围似乎是腹腔镜胰体尾切除术中转开腹的主要因素。
