Comparative Analysis Of Short-term Clinical Efficacy Of Laparoscopic Distal Pancreatectomy And Open Distal Pancreatectomy

Objective: To compare and analyze the intraoperative conditions and postoperative short-term clinical effect between laparoscopic distal pancreatectomy(LDP)and open distal pancreatectomy(ODP),and to investigate the advantages and disadvantages of LDP.Methods: The clinical data of 36 patients who underwent distal pancreatectomy from September 2016 to September 2020 in the Department of Hepatobiliary Pancreatic and splenic surgery of Hebei General Hospitall were analyzed retrospectively.According to the mode of operation,the patients were divided into LDP group(n = 20)and ODP group(n = 16).Compare and analyze the general conditions(gender,age,BMI,tumour size,etc.),intraoperative conditions(intraoperative blood loss,blood-transfusion rate,spleen-preserving rate,etc.)and postoperative conditions(anal exhaust time,postoperative fasting time,postoperative complications)of the patients.Results: LDP group and ODP group both successfully completed the distal pancreatectomy,and all patients were R0 resection.There were 27 patients completed spleen preserving distal pancreatectomy(SPDP),9patients completed distal pancreatectomy with splenectomy(DPS).In LDP group,16 patients were SPDP,4 patients were DPS,and in ODP group 11 patients were SPDP,5 patients were DPS.The general conditions(gender,age,BMI,tumour size,history of upper abdominal surgery)between LDP group and ODP group were not statistically different(P>0.05).The intraoperative conditions,in LDP group,the operation time was(208.50±79.267)min,the intraoperative blood loss was [50(35～300)]ml,intraoperative blood transfusion rate was 15.00%(3/20)slightly shorter than(255.32±97.00)min,[200(50～500)]ml and 31.25%(5/16)in ODP group,but without statistically significant.The rate of intraoperative spleen-preserving in LDP group was80.00%(16/20),which was higher than that in ODP group68.75%(11/16),but there was no statistically significant difference between the two groups(P>0.05).The postoperative conditions,the postoperative fasting time(2.95±0.99 d vs 3.75 ±1.18d),anal exhaust time(2.65±0.671 d vs 3.31±1.20d)and hospital stays(10.10±2.77 d vs 12.56±4.23d)in the LDP group were shorter than that in the ODP group,and the difference was statistically significant.About postoperative complications,there was 4 cases in LDP group,including 2 cases of pancreatic fistula,1 case of splenic infarction,1 case of intra-abdominal hemorrhage,and 3 cases in ODP group,including 1 case of pancreatic fistula,1 case of incision infection and 1 case of hyperglycemia.There was no statistically significant difference in the rate of incidence of postoperative complications(such as pancreatic fistula,abdominal hemorrhage,abdominal infection,etc.)and total complications between the two groups(P>0.05).In terms of pathological types,the proportion of malignant tumors in LDP group was lower than that in ODP group,but there was no significant difference between the two groups(P>0.05).Conclusion: 1.Compared with ODP,LDP has the advantages of faster postoperative recovery and shorter hospital stays,and dose not increased the prolonged operation time and the rate of incidence of postoperative complications.About pancreatic body and tail tumors,LDP is a safe and feasible surgical method,which can be widely used in clinical practice.2.The operation of LDP is difficult,so it is necessary for operating surgeon to choose carefully in the early stage of operation,and the indication of operation can be expanded appropriately after passing the learning curve.