| Objective:Distal pancreatectomy is performed for benign,precancerous and malignant diseases of the pancreatic body or tail.The most primitive,widely applicable,effective and safest is open distal pancreatectomy(ODP).However,with the development of modern science and technology and the improvement of medical level,minimally invasive distal pancreatectomy(MIDP))is becoming the main force in recent years.The purpose of this study was to compare the preoperative general condition,intraoperative index,postoperative recovery and clinicopathological data of minimally invasive distal pancreatectomy(MIDP)and open distal pancreatectomy(ODP)in order to discuss the clinical efficacy,safety and effectiveness of minimally invasive distal pancreatectomy(MIDP)and open distal pancreatectomy(ODP).Methods:The data of patients who underwent distal pancreatectomy in the Department of Hepatobiliary surgery of the affiliated Hospital of Qingdao University from January 2014 to July 2020 were analyzed retrospectively.According to the different surgical methods,the patients were divided into ODP group and MIDP group.A total of 323 patients were included in the statistical analysis.MIDP group was subdivided into LDP and RDP subgroups.MIDP,included 97 cases of LDP and 77 cases of RDP,149 cases underwent ODP,including 13 cases of MIDP transfer to laparotomy(transfer rate 6.95%).Main observation and comparison indicators: 1.Preoperative conditions: included age,sex,body mass index((body mass index BMI)),complication(hypertension,type 2 diabetes),preoperative CEA,CA19-9,albumin,hemoglobin,ASA grade,imaging tumor diameter;2.Intraoperative conditions: include operation time,operative blood loss,intraoperative blood transfusion,spleen preservation,spleen involvement and lymph node metastasis;3.Postoperative recovery: postoperative hospital stay,first feeding time,first exhausting time,postoperative pancreatic fistula,bleeding,abdominal infection,incision infection,30-day death,secondary operation,drainage tube removal time,operation cost,hospitalization cost.4.postoperative pathological related conditions: include pathological type,tumor diameter,R0 resection rate and so on.In addition,in order to reduce the selection deviation,according to the postoperative pathological conditions and preoperative laboratory indexes,the two groups of patients were divided into two groups according to benign and low-grade malignant and malignant diseases.the related indexes and postoperative recovery of benign and low-grade malignant and malignant diseases in the two groups were compared,and then the clinical effects of the two surgical methods were studied.After comparing the two large groups,we continued to compare the postoperative recovery and economic cost between the LDP and RDP subgroups according to the above method.Graph Pad Prism7 and SPSS25.0 statistical software were used for data analysis and processing.Results:The clinicopathological results showed that the malignancy rate of the ODP group was significantly higher than that of the MIDP group(45.0% vs.16.7%,P < 0.05),and the tumor length diameter of the MIDP group was lower than that of the ODP group(P <0.05).Therefore,the comparative analysis of the related indicators of benign and malignant diseases in patients of the two groups showed that there were no statistical differences in baseline data,such as age,gender,BMI,preoperative complications,preoperative albumin,preoperative hemoglobin,ASA grade,CA19-9,CEA,etc.between the MIDP group and the ODP group after grouping(P > 0.05).For pancreatic benign and low-grade malignant diseases and malignant diseases,compared with the ODP group,the MIDP group had higher surgical costs and hospitalization costs(P < 0.05),and there was no difference between the two groups with or without intraoperative blood transfusion(P >0.05).The postoperative hospitalization time,postoperative feeding time,postoperative exhaust time and drainage tube removal time were shorter(P < 0.05).The incidence of postoperative bleeding,secondary operation,postoperative abdominal infection,pancreatic fistula and other complications and mortality within 30 days were not significantly different between the ODP group and the ODP group(P > 0.05).For benign and low-grade malignant tumors,the intraoperative blood loss of MIDP was significantly less than that of ODP,the operative time was shorter,and the intraoperative splenic preservation rate of patients was higher(P < 0.05).For pancreatic malignant tumor,the operative time of MIDP group was longer than that of ODP group(P < 0.05),and there was no difference in intraoperative blood loss(P > 0.05).In the analysis of LDP and RDP subgroups,there was no significant difference in clinicopathological classification,tumor length and R0 resection between the two groups(P > 0.05).There was no significant difference in operation time,intraoperative blood transfusion,postoperative abdominal infection,pancreatic leakage and 30-day mortality between the two groups(P > 0.05).Compared with benign and low-grade malignant diseases,RDP and LDP had less intraoperative blood loss,higher spleen preservation rate,earlier postoperative exhaust time,postoperative feeding time and postoperative hospitalization time,and higher operation and hospitalization expenses.Conclusions:To sum up,MIDP and ODP have similar indications and safety,and have the same effect as R0 resection rate in the occurrence of postoperative complications.Compared with ODP,MIDP group has some advantages,such as less surgical trauma,faster recovery of postoperative gastrointestinal function,shorter postoperative hospital stay and higher spleen preservation rate.For benign and low-grade malignant tumors of the distal pancreas,MIDP,should be selected.For patients with good economic conditions,RDP is a better choice. |
