腹腔镜保留脾脏与非保留脾脏胰体尾切除术的临床疗效和生活质量比较。
Comparison of clinical outcomes and quality of life between laparoscopic distal pancreatectomy with or without spleen preservation.
机构信息
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.
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang Province, China.
出版信息
Surg Endosc. 2021 Jul;35(7):3412-3420. doi: 10.1007/s00464-020-07783-2. Epub 2020 Jul 6.
BACKGROUND
The studies comparing laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and laparoscopic distal pancreatosplenectomy (LDPS) are limited. This study aimed to compare clinical outcomes and quality of life of patients undergoing LSPDP and LDPS.
METHODS
Between March 2004 and December 2014, patients who underwent laparoscopic distal pancreatectomy were reviewed. Patients were divided into 2 groups as LSPDP and LDPS. Data considered for comparison analysis were patient demographics, intraoperative variables, morbidity, postoperative hospital stay, mortality, pathologic findings, and quality of life (SF-36 questionnaire).
RESULTS
A total of 110 patients (50 LSPDP and 60 LDPS) were included in the final analysis. Baseline characteristics were similar in the 2 groups. The LSPDP group had a significantly shorter operative time(153.3 ± 46.2 vs. 179.9 ± 54.1 min, p = 0.015) than the LDPS group. Also in analysis of propensity-matched population(LSPDP:LDPS = 35:35, 1:1 matching), LSPDP group still had a significantly shorter operative time (159.3 ± 36.2 vs. 172.9 ± 44.1 min, p = 0.045) than the LDPS group.There were no significant differences with respect to estimated blood loss, first flatus time, diet start time, and postoperative hospital stay. Postoperative outcomes, including morbidity, pancreatic fistula rates, and mortality, were similar in the LSPDP and LDPS group. On the follow-up survey, the total quality of life score (635.8 ± 50.7 vs. 596.1 ± 92.1)was higher in the LSPDP group compared with the LDPS group. However, the differences were not statistically significant(p > 0.05). The score in vitality (82.5 ± 14.4 vs. 68.9 ± 11.4, p = 0.046) was significantly higher in LSPDP group and not statistically significant in other areas (p > 0.05).Similar results of quality of life assessment were found in analysis of propensity-matched population.
CONCLUSIONS
Compared to LDPS, LSPDP had shorter operating time and better quality of life with similar morbidity and recovery period.
背景
比较腹腔镜保留脾脏胰体尾切除术（LSPDP）和腹腔镜胰体尾切除术（LDPS）的研究有限。本研究旨在比较行 LSPDP 和 LDPS 的患者的临床结果和生活质量。
方法
回顾 2004 年 3 月至 2014 年 12 月期间行腹腔镜胰体尾切除术的患者。患者分为 LSPDP 和 LDPS 两组。比较分析的数据包括患者人口统计学、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）。
结果
共有 110 例患者（50 例行 LSPDP 和 60 例行 LDPS）纳入最终分析。两组的基线特征相似。LSPDP 组的手术时间明显短于 LDPS 组（153.3±46.2 比 179.9±54.1 分钟，p=0.015）。在倾向匹配人群的分析中（LSPDP：LDPS=35：35，1：1 匹配），LSPDP 组的手术时间仍明显短于 LDPS 组（159.3±36.2 比 172.9±44.1 分钟，p=0.045）。估计出血量、首次排气时间、开始进食时间和术后住院时间无显著差异。LSPDP 和 LDPS 组的术后结果，包括发病率、胰瘘发生率和死亡率，相似。在随访调查中，LSPDP 组的总生活质量评分（635.8±50.7 比 596.1±92.1）高于 LDPS 组。然而，差异无统计学意义（p>0.05）。LSPDP 组活力评分（82.5±14.4 比 68.9±11.4，p=0.046）明显高于 LDPS 组，而其他领域差异无统计学意义（p>0.05）。倾向匹配人群的生活质量评估也得出了类似的结果。
结论
与 LDPS 相比，LSPDP 具有较短的手术时间和更好的生活质量，发病率和恢复期相似。
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