| Objective: In this study,through comprehensive analysis of preoperative,intraoperative and postoperative clinical data of pancreaticoduodenectomy(PD)assisted by laparotomy,laparoscopy and robot-assisted pancreaticoduodenectomy,we explored the differences in the short-term efficacy of different surgical methods of PD,to explore the safety,feasibility and effectiveness of PD surgery with different surgical methods,so as to provide experience and basis for clinical diagnosis and treatment.Methods: To collect the clinical data of 139 patients PD in our hospital from January 1,2016 to June 30,2020,Divided into three groups according to PD operation,that is open pancreaticoduodenectomy(OPD),n=86;laparoscopic pancreaticoduodenectomy(LPD),n=21;robotic pancreaticoduodenectomy(RPD),n=32.Results: The operation time(441.5±119.8 min)in OPD group was significantly shorter than that in LPD group(592.9±204.7 min)and RPD group(537.2±126.7min),difference was statistically significant(P<0.05).There was no difference in operation time between LPD group and RPD group(P>0.05).RPD group(12.5±6.3 d)had significantly shorter time to remove the abdominal drainage tube after operation than the OPD group(17.3±8.9d)(P<0.05),there was no difference between the LPD group(18.0d vs.13.9 d)and the RPD group(P>0.05).OPD group(10453.6±3414.7CNY)had lower surgical costs than the LPD group(12410.1±2758.8CNY)and the RPD group(12231.3±2260.7CNY),P<0.05,There was no significant difference between LPD group and RPD group(P>0.05).The total hospitalization cost of RPD group was higher than that of OPD group(127229.3±34343.0CNY vs.108335.5±35376.6CNY,P<0.05),There was no difference between LPD group(125247.6±51610.8CNY)and OPD group and RPD group(P>0.05).The time of removing urinary catheter in LPD group was shorter than that in OPD group(2.3±1.4d vs.3.1±1.7d,P<0.05),There was no difference between the RPD group(2.7±1.8 d)and the LPD group and the OPD group(P>0.05).RPD group had higher life ability score on day 3after operation than LPD group(34.8±16.3 vs.25.7±7.1),P<0.05,there was no difference between OPD group(28.9±12.0)and LPD group and RPD group(P>0.05).The operative transfer rate of RPD group(38.1%,8/21)decreased significantly compared with that of LPD group(6.5%,2/32),P<0.05.There was no significant difference in preoperative data,postoperative feeding time,gastric tube extraction time,preoperative length of hospital stay,postoperative hospitalization time,total hospital stay,life ability score on day 5,postoperative pain score,intraoperative estimated bleeding volume,blood transfusion volume,postoperative pancreatic fistula,biliary fistula and other complications(P>0.05).Postoperative survival analysis results showed that: Postoperative survival analysis of OPD-LPD-RPD patients with different surgical methods showed no statistical significance(P>0.05).Periampullary carcinoma(pancreatic cancer,n=27;carcinoma of the subcommon bile duct,n=18;ampullary carcinoma =8;duodenal adenocarcinoma,n=52)showed: There was no difference in the disease-free survival time of periampullary malignant tumors among the three groups(P>0.05);The disease-free survival time of duodenal adenocarcinoma was longer than that of pancreatic carcinoma,subcommon bile duct carcinoma,and ampullary carcinoma(P<0.05),there was no difference in pancreatic cancer,lower common bile duct cancer and ampullary cancer groups(P>0.05);The predicted postoperative survival time of duodenal adenocarcinoma was better than that of pancreatic cancer(P>0.05);There was no significant statistical significance in the postoperative survival analysis of pancreatic cancer,lower common bile duct cancer,ampullary carcinoma and duodenal adenocarcinoma by different operation modes of OPD-LPD-RPD(P>0.05).LPD group(n=21)was divided into total laparoscopic pancreaticoduodenectomy(TLPD,n=13)group and non-total laparoscopic pancreaticoduodenectomy(NTLPD,n=8)group according to whether the whole procedure was laparoscopic or not.RPD group was divided into total robotic pancreaticoduodenectomy(TRPD,n=30)and non-total robotic pancreaticoduodenectomy(NTRPD,n=2)according to whether or not to open in transit.TLPD group and NTLPD group were compared with TRPD group respectively,the results showed that the TLPD group(673.2±196.7min)was significantly higher than the NTLPD group(462.4±148.2min)and the TRPD group(535.1±129.1min)in the operation time(P<0.05);There was no significant difference in operation time between NTLPD group and TRPD group(P>0.05).TRPD group had significantly less intraoperative bleeding than TLPD group(405.0±528.2ml vs.507.7±322.7ml,P<0.05),there was no significant difference between NTLPD group(643.8±574.1ml)and TLPD group and TRPD group(P>0.05).The time of removing abdominal drainage tube in TRPD group was earlier(12.1±6.2d vs.20.3±16.3d,P<0.05),but there was no significant difference between NTLPD group(14.3±8.4d)and TLPD group and TRPD group(P>0.05).TRPD group had higher life ability score on 3 days after operation than TLPD group(35.8±16.1 vs.24.2±5.3,P<0.05),There was no significant difference between the NTLPD group(28.1±9.2)and the TLPD group and the TRPD group(P>0.05).The incidence of postoperative complications between TLPD group,NTLPD group and RPD group was not statistically significant(P>0.05).The RPD group(n=32)was divided into pre-RPD(n=20)group and post-RPD group(n=12)according to the operation schedule.on day 3 after operation.Subgroup analysis showed that the life ability score on the 3rd day after surgery,the post-RPD group(42.5±18.2)was significantly higher than the pre-group(30.3±13.5),difference was statistically significant(P<0.05);The average blood loss and blood transfusion in post-RPD group were less than those in pre-RPD group,(237.5ml vs.630.0ml、158.3ml vs.690.0ml),but the two groups were not statistically significant(P>0.05);There was no significant difference in postoperative complications between the pre-RPD group and the post-RPD group(P>0.05).Conclusion: RPD group has higher operation time,operation cost and total hospitalization cost than OPD group,but the time of removing abdominal drainage tube was shortened obviously after operation;RPD group was significantly lower than LPD group on the 3rd day after operation,the scores of living ability increased significantly;LPD group was more expensive than OPD group in operating costs,but the time of removing catheter was shorter after operation;Subgroup analysis showed,TRPD group had short operation time,less bleeding,short time to remove abdominal drainage tube and high score of postoperative life ability.However,OPD-LPD-RPD group,TRPD-TLPD group and RPD-NTLPD group showed no difference in the amount of intraoperative blood transfusion,postoperative pancreatic fistula,biliary fistula,abdominal hemorrhage and other complications.The postoperative survival analysis of OPD-LPD-RPD group and the postoperative survival analysis of pancreatic cancer,lower common bile duct cancer,ampullary carcinoma and duodenal adenocarcinoma showed no difference in the OPD-LPD-RPD group with different surgical methods.To sum up,According to our data,RPD had significant advantages in operative time,intraoperative blood loss,postoperative extraction of abdominal drainage tube and urinary catheter,operative transfer rate and postoperative life ability recovery.RPD is a safe,feasible and effective procedure. |
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