Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
J Hepatobiliary Pancreat Sci. 2023 Jul;30(7):962-969. doi: 10.1002/jhbp.1306. Epub 2023 Feb 7.
Previous studies have reported that laparoscopic distal pancreatectomy (LDP) has an advantage in reducing blood loss over open distal pancreatectomy (ODP). This study was performed to investigate whether blood loss is truly reduced in LDP.
A total of 113 patients undergoing DP from 2014 to 2022 were classified into Open and LDP groups and compared by statistical analysis. Estimated blood loss (EBL) was calculated from the perioperative changes in the hematocrit, hemoglobin, or red blood cell volume, and actual blood loss (ABL) was taken from the operative record.
ABL was significantly lower in the LDP than ODP group (50[5-1350] vs 335 [5-1950] ml, P < .01). However, there were no significant differences in EBL calculated from the hematocrit (406 [66-1990] vs 540 [23-1490] ml, P = .14), hemoglobin, or red blood cell volume. EBL showed more linear correlations with ABL in the ODP group (r = 0.64-0.73) than in the LDP group (r = 0.52-0.57). In the multivariate analysis for ABL, ODP (P = .02) and operative time (P < .01) were significant factors. In contrast, no significant factors were found for EBL.
Intraoperative blood loss may be underestimated in LDP, and a new evaluation method needs to be established.
先前的研究报告表明，腹腔镜胰体尾切除术（LDP）在减少出血量方面优于开腹胰体尾切除术（ODP）。本研究旨在探讨 LDP 是否确实能减少出血量。
回顾性分析 2014 年至 2022 年期间行 DP 的 113 例患者的临床资料，根据手术方式分为开腹组和腹腔镜组，采用统计学方法进行分析。通过围手术期红细胞比容、血红蛋白或红细胞体积的变化计算估计失血量（EBL），并从手术记录中获取实际失血量（ABL）。
LDP 组的 ABL 明显低于 ODP 组（50[5-1350] vs 335 [5-1950] ml，P < .01）。然而，从红细胞比容（406 [66-1990] vs 540 [23-1490] ml，P = .14）、血红蛋白或红细胞体积计算的 EBL 两组间无明显差异。ODP 组 EBL 与 ABL 呈更线性相关（r = 0.64-0.73），而 LDP 组呈弱线性相关（r = 0.52-0.57）。多因素分析显示，ODP（P = .02）和手术时间（P < .01）是 ABL 的显著影响因素。而 EBL 无明显影响因素。
LDP 术中出血量可能被低估，需要建立新的评估方法。
