Objective: To explore the clinical application value of modified peritoneal priority laparoscopic pancreatoduodenectomy;To explore the impact of regional lymph node dissection on the perioperative complications of laparoscopic pancreaticoduodenectomyMethods:Collect clinical data of patients who underwent modified peritoneal priority laparoscopic pancreatoduodenectomy and traditional laparoscopic pancreaticoduodenectomy at Lanzhou University First Hospital from January 2017 to December 2022,and compare their general information,intraoperative relevant clinical indicators,postoperative pathological examination indicators,and perioperative complications;Statistical analysis of the impact of regional lymph node dissection on the perioperative complications of laparoscopic pancreaticoduodenectomy.Results:(1)Comparison of short-term efficacy between modified peritoneal priority laparoscopic pancreatoduodenectomy and traditional laparoscopic pancreaticoduod enectomy.Compared with the traditional laparoscopic pancreaticoduodenectomy group,the modified peritoneal priority laparoscopic pancreatoduodenectomy has more advantages in cleaning the retroperitoneal lymph nodes;The modified peritoneal priority laparoscopic pancreatoduodenectomy group had shorter oral feeding time and lower incidence of B/C grade gastrointestinal emptying disorders.(2)Analysis of risk factors related to perioperative complications(1)Post pancreatic lymph node dissection,operation time,and the number of lymph nodes around superior mesenteric artery were independent risk factors for increased intraoperative bleeding.(2)The number of lymph node dissection at the dorsal lower margin of the pancreas and the posterior head of the pancreas are independent risk factors for the occurrence of conversion to open surgery Periduodenal lymph node dissection is an independent risk factor for the occurrence of B/C grade pancreatic fistula.(4)Peripancreatic lymph node dissection is an independent protective factor for postoperative bleeding.The number of gastric lymph node dissection and abdominal infection are independent risk factors for postoperative bleeding.(5)Periduodenal lymph node dissection is an independent protective factor for the occurrence of abdominal infection.The number of lymph nodes around superior mesenteric artery,postoperative bleeding,and B/C gastric emptying disorder were independent risk factors for abdominal infection.(6)Parahepatic lymph node dissection and B/C grade pancreatic fistula are independent risk factors for postoperative secondary surgery.(7)Lymph node dissection,oral feeding time,and abdominal infection are independent risk factors for the occurrence of B/C grade gastric emptying disorders.(8)Postoperative bleeding is an independent risk factor for increased Clavien Hind score Postoperative admission to ICU,B/C grade pancreatic fistula,and abdominal infection are independent risk factors for increased hospital stay Postoperative admission to the ICU and abdominal infection are independent risk factors for significantly increased hospitalization costs.Conclusions :Improved retroperitoneal priority in modified peritoneal priority laparoscopic pancreatoduodenectomy has advantages in lymph node dissection and retroperitoneal lymph node dissection;The improved retroperitoneal priority in modified peritoneal priority laparoscopic pancreatoduodenectomy group had shorter oral feeding time and lower incidence of B/C grade gastric emptying disorders;The breadth and depth of regional lymph node dissection have a certain impact on the occurrence of perioperative complications;The occurrence of perioperative complications prolongs the patient’s hospitalization time and increases their hospitalization costs. |