Comparative Analysis Of Laparoscopic Pancreaticoduodenectomy And Open Pancreaticoduodenectomy

Objective:The clinical data of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in the treatment of pancreatic cancer and periampullary tumors were collected,sorted and statistically analyzed.Comparative analysis of laparoscopic resection of pancreatic duodenal pancreatic duodenal resection in the treatment of pancreatic cancer and laparotomy and ampulla around tumor curative effects,to confirm that whether laparoscopic resection of pancreas duodenum is safe and feasible,whether can be the same as other laparoscopic surgery minimally invasive effect and the principle of radical tumor,laparoscopic surgery for the clinical treatment of pancreatic cancer and ampulla around tumor provide certain guiding significance.Methods:A retrospective analysis was performed on 66 patients who underwent pancreaticoduodenectomy in the second hospital of jilin university from January 2017 to January 2019.Among them,7 patients were excluded from postoperative pathological diagnosis of inflammation or pancreatic duct stones,and 1 patient was transferred to laparotomy.A total of 58 patients were included in this study.Group of laparoscopic resection of pancreatic duodenal pancreatic duodenal resection group LPD and group OPD in patients with preoperative basic data,ASA grade,operation time,intraoperative blood transfusion,length of hospital stay,hospital expenses,intraoperative resected lymph node number and amount of lymph node positive rate and postoperative pathology,postoperative ICU time,postoperative pain,postoperative exhaust time,postoperative into liquid diets for the first time for the first time time,number of postoperative fever,postoperative complications and other aspects of statistical analysis,draw the conclusion.Results:There were 23 patients in the LPD group,including 10 males and 23 females,aged 59.87 7.36 years.There were 35 patients in the OPD group,including 21 males and 14 females,aged 62.94 9.68 years.Preoperative ASA score,LPD group Ⅰ level 13 cases,Ⅱ level 8 cases,Ⅲ level 2 cases;OPD group Ⅰ level 13 cases,Ⅱ level 16 cases,Ⅲ level 6 cases.Preoperative data(including gender,age and ASA score)of the two groups were not statistically different,and the data of the two groups were comparable.Intraoperative and postoperative data were as follows.Operation time: LPD group(551.87±76.40)min vs.OPD group(306.00±64.748)min,P < 0.001;Intraoperative blood transfusion volume: LPD group(390.43 ± 96.25)ml vs.OPD(338.86 ± 55.59)ml,P=0.621;Postoperative ICU stay: LPD group(0.13±0.95)d vs.OPD group(0.03±0.03)d,P=0.234;Postoperative fever: 2.30±0.54 times in the LPD group and 2.03±0.58 times in the OPD group,P=0.742.Postoperative exhaust time: LPD group(5.05±0.48),d vs.OPD group(5.83±0.38)d,P=0.199;Postoperative feeding time: LPD group(8.70±0.58)d vs.OPD group(12.80±1.33)d,P=0.007;Postoperative hospital stay: LPD group(16.87±0.96)d vs.OPD group(23.17±3.26)d,P=0.131;Hospitalization cost: RMB:114018.59±5436.98 for LPD group vs.RMB:94846.25±5828.52 for OPD group,P=0.027;Number of lymph nodes resected: LPD group(12.09±1.38)group vs.OPD group(14.83±1.51)group,P=0.213;Positive lymph node number: LPD group(0.83±0.22)group vs.OPD group(0.63±0.19)group,P=0.512;There was no significant difference in the incidence and total incidence of complications such as pancreatic leakage,biliary leakage,postoperative bleeding,chylous fistula,gastric emptying disorder,pulmonary infection,incision infection,incision fat liquefaction,pleural effusion,peritoneal effusion and stress ulcer.R0 resection was achieved in both groups,and no perioperative death was observed.Conclusions:1、Through the analysis of LPD and OPD around the treatment of pancreatic head carcinoma and ampullary carcinoma treatment effect of moderate,LPD group of operation for a long time,hospitalization cost is higher,but the eating time early,while the average intraoperative blood loss,intraoperative blood transfusion rate,intraoperative cleaning the living number of lymph nodes,postoperative ICU time,number of average hospital stay,postoperative analgesia after operation,postoperative exhaust time,postoperative fever times for the first time,postoperative complications and no difference between the two groups.2 、 LPD surgery is more complex,and compared with other abdominal surgery,the learning curve is relatively longer,so it is necessary to strictly grasp the indications,fixed surgical team and rich surgical experience.3、Compared with the initial stage of LPD,great progress has been made in surgical duration and postoperative complications,etc.With the continuous progress of laparoscopic diagnosis and the continuous improvement of surgical instruments and anastomosis technology,as well as the advantages brought by its own minimally invasive technique,the advantages of LPD will become more and more obvious.4、LPD is still the most complex and difficult surgery in general surgery at present,but the safety,feasibility and effectiveness of the surgery have been confirmed,which can be popularized in large diagnosis and treatment centers with rich experience and technical conditions.