Toya Keisuke, Tomimaru Yoshito, Kobayashi Shogo, Sasaki Kazuki, Iwagami Yoshifumi, Yamada Daisaku, Noda Takehiro, Takahashi Hidenori, Doki Yuichiro, Eguchi Hidetoshi
Department of Gastroenterological Surgery, Graduate School of Medicine Osaka University Osaka Japan.
Ann Gastroenterol Surg. 2025 Jan 6;9(3):569-577. doi: 10.1002/ags3.12888. eCollection 2025 May.
Decreasing intraoperative blood loss is one reported advantage of laparoscopic surgery compared with open surgery. However, several reports indicate that blood loss during laparoscopic surgery may be underestimated. No studies have evaluated this possibility in laparoscopic distal pancreatectomy (LDP). Here we evaluated estimated blood loss (e-BL) compared to intraoperative blood loss (i-BL) during distal pancreatectomy (DP).
This study included 114 patients undergoing DP in our institution during the study period. We examined the relationship between i-BL and e-BL. Based on these results, we further investigated the relationship with LDP.
The laparoscopic approach was used in a significantly higher percentage of patients in e-BL > i-BL group compared to e-BL < i-BL group (55.9% vs 10.9%, < 0.0001). Within the LDP group ( = 39), e-BL was significantly more than i-BL (388 ± 248 vs 127 ± 160 mL; < 0.0001). Within the open distal pancreatectomy (ODP) group ( = 75), e-BL was significantly less than i-BL (168 ± 324 vs 281 ± 209 mL; 0.0017). The e-BL > i-BL trend in the LDP group was consistent, regardless of the indication for DP. In contrast, the finding of i-BL > e-BL in the ODP group was limited to patients with pancreatic cancer.
During LDP, e-BL was significantly more than i-BL. During ODP, e-BL was significantly less than i-BL, only in patients with pancreatic cancer. These results suggested the possibility of i-BL underestimation during LDP, and overestimation during ODP in cases with pancreatic cancer.
与开放手术相比，减少术中失血是腹腔镜手术的一个公认优势。然而，一些报告表明腹腔镜手术期间的失血量可能被低估。尚无研究评估腹腔镜胰体尾切除术（LDP）中这种可能性。在此，我们评估了胰体尾切除术（DP）期间估计失血量（e-BL）与术中失血量（i-BL）的情况。
本研究纳入了研究期间在我们机构接受DP的114例患者。我们检查了i-BL与e-BL之间的关系。基于这些结果，我们进一步研究了与LDP的关系。
与e-BL＜i-BL组相比，e-BL＞i-BL组中采用腹腔镜手术的患者比例显著更高（55.9%对10.9%，P＜0.0001）。在LDP组（n = 39）中，e-BL显著多于i-BL（388±248对127±160 mL；P＜0.0001）。在开放胰体尾切除术（ODP）组（n = 75）中，e-BL显著少于i-BL（168±324对281±209 mL；P = 0.0017）。无论DP的适应证如何，LDP组中e-BL＞i-BL的趋势是一致的。相比之下，ODP组中i-BL＞e-BL的情况仅限于胰腺癌患者。
在LDP期间，e-BL显著多于i-BL。在ODP期间，仅在胰腺癌患者中e-BL显著少于i-BL。这些结果提示LDP期间可能存在i-BL低估，而在胰腺癌病例的ODP期间可能存在高估。
