Clinical Study Of Laparoscopic And Open Distal Pancreatectomy

Objective: To compare and analyze the short-term and long-term curative effect and hospitalization cost difference between Laparoscopic Distal Pancreatectomy(LDP)and Open Distal Pancreatectomy(ODP)in the treatment of patients with Tumor of body and tail of pancreas,so as to provide guidance for the choice of operation mode of patients with Tumor of body and tail of pancreas.To analyze the causes of postoperative pancreatic fistula and find out the clinical intervention methods.Methods: The clinical data of 66 patients who underwent distal pancreatectomy from August 1,2017 to August 30,2019 in Hepatobiliary Surgery Affiliated Hospital of Jining Medical College were analyzed retrospectively,including 32 patients with LDP(LDP group)and 34 patients with ODP(ODP group).The operative mortality,tumor recurrence/ metastasis rate,intraoperative and intraoperative bleeding volume,postoperative hospitalization time,postoperative complication rate,hospitalization cost and other indicators were analyzed.66 patients were divided into pancreatic fistula group(13 cases)and non pancreatic fistula group(53 cases).The age,gender,tumor pathological type,BMI,reinforcement and suture of the stump,preoperative blood amylase andother indicators were statistically analyzed.Results: 1.There was no statistical significance between LDP group and ODP group in operation time,bleeding volume,spleen preservation rate,drainage tube removal time after operation,incidence of total complications after operation,incidence of abdominal bleeding,incidence of knife edge infection,incidence of lung infection,incidence of pancreatic fistula,incidence of gastric emptying disorder,mortality,recurrence/ metastasis rate of tumor(P>0.05).2.There was no significant difference in age,gender,BMI,pathological type of tumor,and reinforcement and suture of stump between pancreatic fistula group and non pancreatic fistula group(P>0.05).3.In LDP group,the time of first eating,first anal exhaust,gastric tube retention,urinary tube retention,hospitalization expenses(from the first day of admission to discharge)and postoperative hospitalization time were less than those in ODP group(P<0.05).4.The WBC value of ODP group was significantly higher than that of LDP group(P<0.05).5.The level of serum amylase and albumin in patients with pancreatic fistula was higher than that in patients without pancreatic fistula(P<0.05).Conclusion:1.There was no death in the patients of LDP and ODP group,no significant difference in the incidence of postoperative complications in the near and long term,and no significant difference in the rate of spleenpreservation.LDP and ODP are equally safe and feasible in the treatment of tumor of body and tail of pancreas.2.The recovery of patients in LDP group was faster than that in ODP group.Based on the factors of economy,short-term and long-term effect after operation and the clinical skills of the operator,we first recommend Laparoscopic Distal Pancreatectomy.However,in the clinical work,we should start from the interests of the patients and choose the best operation.When we fail to master the laparoscopic technology,ODP is recommended.3.For patients with high serum amylase and low serum albumin,more attention should be paid to the occurrence of pancreatic fistula.