腹腔镜胰腺切除术治疗良性或低级别恶性胰腺肿瘤：单一大容量中心的结果。
Laparoscopic pancreatectomy for benign or low-grade malignant pancreatic tumors: outcomes in a single high-volume institution.
机构信息
Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Department of Minimal Invasive Surgery, Shangjin Nanfu Hosptial, Chengdu, China.
出版信息
BMC Surg. 2021 Dec 7;21(1):412. doi: 10.1186/s12893-021-01414-w.
OBJECTIVE
To investigate the perioperative and long-term outcomes of laparoscopic pancreatectomy for benign and low-grade malignant pancreatic tumors, and further compare the outcomes between different surgical techniques.
METHODS
We retrospectively collected clinical data of consecutive patients with benign or low-grade malignant pancreatic tumors underwent surgery from February 2014 to February 2019. Patients were grouped and compared according to different surgical operations they accepted.
RESULTS
Totally 164 patients were reviewed and 83 patients underwent laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD), 41 patients underwent laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and 20 patients underwent laparoscopic central pancreatectomy (LCP) were included in this study, the rest 20 patients underwent laparoscopic enucleation were excluded. There were 53 male patients and 91 female patients. The median age of these patients was 53.0 years (IQR 39.3-63.0 years). The median BMI was 21.5 kg/m (IQR 19.7-24.0 kg/m). The postoperative severe complication was 4.2% and the 90-days mortality was 0. Compare with LCP group, the LPPPD and LSPDP group had longer operation time (300.4 ± 89.7 vs. 197.5 ± 30.5 min, P < 0.001) while LSPDP group had shorter operation time (174.8 ± 46.4 vs. 197.5 ± 30.5 min, P = 0.027), more blood loss [140.0 (50.0-1000.0) vs. 50.0 (20.0-200.0) ml P < 0.001 and 100.0 (20.0-300.0) vs. 50.0 (20.0-200.0 ml, P = 0.039, respectively), lower rate of clinically relevant postoperative pancreatic fistula [3 (3.6%) vs. 8 (40.0%), P < 0.001 and 3 (7.3%) vs. 8 (40.0%), P = 0.006, respectively], lower rate of postpancreatectomy hemorrhage [0 (0%) vs. 2 (10.0%), P = 0.036 and (0%) vs. 2 (10.0%) P = 0.104, respectively] and lower rate of postoperative severe complications [2 (2.4%) vs.4 (20.0%), P = 0.012 and 0 (0%) vs. 4 (20.0%), P = 0.009, respectively], higher proportion of postoperative pancreatin and insulin treatment (pancreatin: 39.8% vs., 15% P = 0.037 and 24.4%vs. 15%, P = 0.390; insulin: 0 vs. 18.1%, P = 0.040 and 0 vs. 12.2%, P = 0.041).
CONCLUSIONS
Overall, laparoscopic pancreatectomy could be safely performed for benign and low-grade malignant pancreatic tumors while the decision to perform laparoscopic central pancreatectomy should be made carefully for fit patients who can sustain a significant postoperative morbidity and could benefit from the excellent long-term results even in a high-volume center.
目的
探讨腹腔镜胰腺良性和低级别恶性肿瘤切除术的围手术期和长期结果，并进一步比较不同手术技术的结果。
方法
我们回顾性收集了 2014 年 2 月至 2019 年 2 月连续接受手术治疗的良性或低级别胰腺肿瘤患者的临床资料。根据患者接受的不同手术方式进行分组和比较。
结果
共纳入 164 例患者，其中 83 例行腹腔镜保留幽门胰十二指肠切除术（LPPPD），41 例行腹腔镜保留脾脏胰体尾切除术（LSPDP），20 例行腹腔镜中央胰腺切除术（LCP），20 例行腹腔镜胰腺肿瘤剜除术患者被排除在外。男性 53 例，女性 91 例。患者的中位年龄为 53.0 岁（IQR 39.3-63.0 岁）。中位 BMI 为 21.5kg/m（IQR 19.7-24.0kg/m）。术后严重并发症发生率为 4.2%，90 天死亡率为 0。与 LCP 组相比，LPPPD 和 LSPDP 组手术时间更长（300.4±89.7 分钟 vs. 197.5±30.5 分钟，P<0.001），而 LSPDP 组手术时间更短（174.8±46.4 分钟 vs. 197.5±30.5 分钟，P=0.027），术中出血量更多[140.0（50.0-1000.0）ml vs. 50.0（20.0-200.0）ml，P<0.001；100.0（20.0-300.0）ml vs. 50.0（20.0-200.0）ml，P=0.039]，术后临床相关胰瘘发生率更低[3（3.6%）例 vs. 8（40.0%）例，P<0.001；3（7.3%）例 vs. 8（40.0%）例，P=0.006]，术后胰腺出血发生率更低[0（0%）例 vs. 2（10.0%）例，P=0.036；0（0%）例 vs. 2（10.0%）例，P=0.104]，术后严重并发症发生率更低[2（2.4%）例 vs. 4（20.0%）例，P=0.012；0（0%）例 vs. 4（20.0%）例，P=0.009]，术后胰酶和胰岛素治疗的比例更高（胰酶：39.8% vs. 15%，P=0.037；24.4% vs. 15%，P=0.390；胰岛素：0 例 vs. 18.1%，P=0.040；0 例 vs. 12.2%，P=0.041）。
结论
总的来说，腹腔镜胰腺切除术可安全用于治疗良性和低级别胰腺肿瘤，但对于适合行腹腔镜中央胰腺切除术的患者，应谨慎决定，因为这些患者术后发生严重并发症的风险较高，但在高容量中心仍能获得良好的长期结果。
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