Ishikawa Yoshiya, Ban Daisuke, Watanabe Shuichi, Akahoshi Keiichi, Ono Hiroaki, Mitsunori Yusuke, Kudo Atsushi, Tanaka Shinji, Tanabe Minoru
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Asian J Endosc Surg. 2019 Jan;12(1):81-87. doi: 10.1111/ases.12485. Epub 2018 Apr 15.
The use of laparoscopic distal pancreatectomy (LDP) is increasing worldwide. It is important for surgeons to predict preoperatively the difficulty and risks of a surgery. However, very few reports have evaluated the impact of patient or tumor factors on the difficulty of LDP. We aimed to determine the predictors of technical difficulties when performing LDP.
This study included 34 patients who underwent LDP. Patient information was obtained retrospectively and included age, gender, BMI, primary disease, previous abdominal surgery, previous pancreatitis, tumor size, tumor proximity to the splenic arterial origin, type of splenic artery (SpA), operative time, blood loss, postoperative pancreatic fistula, and length of hospital stay. Univariate and multivariate analyses were performed to determine the predictors of a long operative time. SpA anatomy was classified into two types based on the relationship between its origin and the pancreas. Patients whose SpA origin was upward of the pancreatic parenchyma were classified as SpA type 1, whereas patients whose SpA origin was covered by the pancreatic parenchyma were classified as SpA type 2.
Multivariate analysis revealed SpA type 2 to be an independent risk factor for a long operation (odds ratio = 9.925; 95% confidence interval: 1.461-67.412; P = 0.019). SpA type 2 was related to a longer operative time (P < 0.001) and greater intraoperative blood loss (P = 0.001).
Classification according to SpA type is simple and useful for predicting technical difficulty when performing LDP.
腹腔镜远端胰腺切除术（LDP）在全球范围内的应用日益增多。对外科医生而言，术前预测手术的难度和风险很重要。然而，极少有报告评估患者或肿瘤因素对LDP手术难度的影响。我们旨在确定实施LDP时技术难度的预测因素。
本研究纳入了34例行LDP的患者。回顾性获取患者信息，包括年龄、性别、体重指数、原发疾病、既往腹部手术史、既往胰腺炎史、肿瘤大小、肿瘤与脾动脉起始部的距离、脾动脉（SpA）类型、手术时间、失血量、术后胰瘘及住院时间。进行单因素和多因素分析以确定手术时间延长的预测因素。根据SpA起始部与胰腺的关系将SpA解剖结构分为两种类型。SpA起始部位于胰腺实质上方的患者被归类为SpA 1型，而SpA起始部被胰腺实质覆盖的患者被归类为SpA 2型。
多因素分析显示SpA 2型是手术时间延长的独立危险因素（比值比=9.925；95%置信区间：1.461 - 67.412；P = 0.019）。SpA 2型与更长的手术时间（P < 0.001）和更多的术中失血量（P = 0.001）相关。
根据SpA类型进行分类对于预测实施LDP时的技术难度简单且有用。
