| Objectives: To study the clinical efficacy of LDP and ODP in the treatment of leftsided pancreatic lesions Methods: From January 2014 to March 2019,the clinical data of 206 cases of distal pancreatectomy in the biliary and pancreatic surgery of Tongji Hospital were analyzed retrospectively.These cases were divided into ODP group(78 cases)and LDP group(128 cases)according to the operation methods.A comparative analysis of the perioperative clinical data of two groups was performed.Results: There were no significant differences in the baseline data between ODP and LDP groups(P > 0.05).In the pathological results,there were 82 benign cases,71 cases of low grade malignancy or borderline malignancy and 53 malignant cases.Compared with the ODP group,the operation time of LDP group was shorter(220(167.0-288.5)min vs 261.5(210-337.75)min,P = 0.029),the amount of bleeding was less(100(50-300)ml vs 350(87.5-725)ml,P = 0.001),the proportion of blood transfusion was lower(9(7%)vs 16(20.5%),P = 0.001).In the aspect of spleen preservation,the success rate of spleen preservation was 43(33.9%)was higher in LDP than that of ODP(16(20.7%),and the difference was statistically significant(P = 0.046).Among the choice of methods of splenic preservation,the ODP preferred the Kimura method [Kimura 16(100%)vs Warshaw 0,P = 0.004].All the patients recovered smoothly without perioperative death.According to Clavien-Dindo classification,the incidence of complications in grade III and IV was 12.8% and 21.1% in ODP and LDP group respectively,with no significant difference(P = 0.198).In terms of postoperative pancreatic fistula,there were 16 cases(20.5%)in ODP group,26 cases(20.3%)in LDP group.In terms of length of stay,the median length of first hospitalization(IQR)in ODP group was 28(22-36)days,which was longer than that in LDP group(IQR),which was 25(19.5-30)days,showing a statistical difference(P =0.04).Conclusion: Laparoscopic distal pancreatectomy for left-sided lesions can be safely and effectively performed in the benign or low-graded malignant lesions,as well as selected malignant lesions.Moreover,compared with ODP,LDP decreases the first hospital stay with the minimally invasive advantages of shorter operation time,less intraoperative bleeding and lower transfusion ratio.Objectives: With the development of LDP,the surgical methods and related techniques have been improved,but the incidence of postoperative pancreatic fistula is still high.To explore the risk factors of pancreatic fistula after distal pancreatectomy is the key to prevention and treatment of postoperative pancreatic fistula.Methods: Clinical data of 206 patients receiving distal pancreatectomy in Tongji hospital,affiliated to Tongji medical college of Huazhong university of science and technology from January 2014 to March 2019 were retrospectively analyzed,and risk factors of clinical pancreatic fistula after distal pancreatectomy were analyzed by univariable analysis and multivariable logistic regression.Results: In this study,206 patients underwent distal pancreatectomy,including 123 females and 83 males.The overall morbidity was 30.1%(62/206),with 41 cases(19.9%)of grade B pancreatic fistula and 1 case(0.5%)of grade C pancreatic fistula.These cases were divided into PF group(42 cases)and non-PF group(164 cases)according to whether postoperative pancreatic fistula occurred.In the analysis of postoperative data,compared with the non-PF group,the incidence of PF-related complications such as delayed gastric emptying(P=0.005),postpancreatectomy hemorrhage(P=0.007),abdominal abscess(P=0.007),wound infection(P=0.001),and percutaneous drainage of abdominal effusion(P<0.001)was higher in the PF group,and there was a statistically significant difference between the two groups.At the same time,the differences between the two groups were also statistically significant in terms of length of first hospitalization,length of postoperative hospitalization,total length of hospitalization,30-day and 90-day readmission rate(P <0.001).The results of univariable analysis on the risk factors of postoperative pancreatic fistula showed that the occurrence of pancreatic fistula was related to BMI>25 kg/m2(OR=2.600,P=0.039)and splenic vessel resction(OR=0.450,P=0.039).The multivariable analysis showed that preoperative BMI>25kg/m2(OR=2.637,P<0.05)and preoperative serum pancreatic amylase >53U/L(OR=2.658,P<0.05)were independent risk factors of clinical related-postoperative pancreatic fistula.Conclusion: The occurrence of pancreatic fistula increases the incidence of postoperative complications and the rate of rehospitalization at 30 and 90 days,and prolongs the length of first hospitalization,the length of postoperative hospitalization and the total length of hospitalization,and correspondingly increases the economic burden.BMI>25 kg/m2 and preoperative serum pancreatic amylase >53U/ L are risk factors of pancreatic fistula,and effective preventive measures should be further studied according to the risk factors mentioned above. |
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