Comparative Analysis Of The Clinical Efficacy Of Different Spleen-preserving Distal Pancreatectomy

Objective:Distal pancreatectomy（DP）is the current standard treatment for space occupying lesions in the body and tail of the pancreas.Because the tail of the pancreas is adjacent to the spleen,it is usually combined with splenectomy.However,with the deepening of the understanding of the function of the spleen,spleen preserving distal pancreatectomy（SPDP）has gradually become the standard operation for benign and low-grade malignant tumors in the body and tail of the pancreas.SPDP includes Kimura method and Warshaw method.At present,there are still disputes about the selection of the two methods and their impact on postoperative complications.This paper will analyze the clinical curative effect by comparing the basic situation,intraoperative situation and the incidence of postoperative complications of the two methods,and summarize the surgical experience of spleen preserving pancreatectomy,so as to provide a basis for the rational selection of methods To provide basis for better prevention and treatment of postoperative complications.Research methods:The clinical data of 41 patients who underwent splenic preserving pancreatectomy for space occupying lesions of pancreatic body and tail treated in China-Japan Union Hospital of Jilin University from January2017 to November 2021 were studied retrospectively.They were divided into Kimura group and Warshaw group according to the mode of operation.The preoperative data,intraoperative conditions,postoperative recovery,complications and other data of patients are analyzed statistically,in which the measurement data in line with the normal distribution are represented by X ±s,the data between the groups are compared by t test method,the measurement data of partial distribution are represented by M（range）,the data between the groups are compared by nonparametric rank-sum test method,and the data between the counting data are used by chi-square test or Fisher accurate probability test.Results:There were 41 patients,including 14 males and 27 females,aged from 33 to 70 years,with an average age of 50.5 years.According to the operation method is divided into Kimura and Warshaw group,Kimura group 29 cases,the remaining 12 cases for Warshaw group.There were11 cases of laparotomy,21 cases of laparoscopy and 9 cases of robot surgery.There was no significant difference between Kimura group and Warshaw group in basic conditions such as age,gender,preoperative albumin and surgical cases including operation time,intraoperative bleeding,intraoperative blood transfusion and pathological type of tumor.There was significant difference in tumor size which has a vital impact on the final completion of splenic vascular preservation.There was no significant difference between the two methods in postoperative complications,hospital stay and other postoperative conditions.There was no significant difference in tumor size,postoperative eating time,incidence of postoperative complications and postoperative hospital stay.In terms of operation time,there was no difference between laparotomy group,laparoscopy group and robot group,but the operation time in robot group was significantly shorter than that in laparoscopy group.In terms of intraoperative bleeding,there was no significant difference between laparotomy and laparoscopy,and robot surgery was significantly better than laparotomy and laparoscopy.In terms of the total length of hospital stay,there was no significant difference between laparoscopic surgery and robotic surgery,but the open group was significantly longer than laparoscopic group and robotic group.Conclusions:There were no significant differences in intraoperative indexes,postoperative recovery indexes and therapeutic effects between Kimura method and Warshaw method.It is suggested that Warshaw method should be the first choice to preserve spleen when the tumor is > 5cm or closely related to blood vessels and splenic hilum.Kimura method is the first choice when the tumor is small and the anatomical relationship is clear.Splenectomy should be combined with splenectomy decisively when splenic blood transport is poor during operation.In terms of the selection of surgical approaches,robotic surgery is preferred,followed by laparoscopic surgery.In case of intraoperative bleeding and difficult separation of masses,the robotic surgery should be converted to laparoscopic or open surgery timely.There was no significant difference in the incidence of pancreatic fistula between the two methods.In order to prevent pancreatic fistula,appropriate instruments were selected during pancreatic dissection,and the main pancreatic duct and pancreas section were ligation after pancreatic dissection.Regular postoperative monitoring was performed to detect pancreatic fistula in time and treat it as soon as possible to improve the prognosis.