Clinical Analysis Of Laparoscopic Pancreatectomy With Or Without Splenectomy

Objective:nowadays the literature research about laparoscopic distal pancreatectomy at home and abroad is mostly case reports or comparative studies between laparoscopy and laparotomy.But there was a lack of comparative analysis of large cases of Laparoscopic spleen-preserving distal Panereatectomy(LSPDP)and Laparoscopic distal Panereatectomy with splenectomy(LDPS).In this study,the clinical efficacy and pathological results of group LSPDP and group LDPS was compared and analyzed,in order to explore the feasibility,safety and advantages of LSPDP compared with LDPS,to compare preserving spleen and cutting spleen of the benign and malignant tumor of the pancreas,summarize the experience of operation and the adaptability of LSPDP to the benign and malignant tumors,and provide the basis for clinical treatment.Methods:59 cases of laparoscopic pancreatectomy excluded of laparotomy,admitted to the hepatobiliary surgery department of Shangdong Provincial Hospital from October 2012 to October 2017.Include 27 cases of Laparoscopic spleen-preserving distal Panereatectomy(group LSPDP),and 32 cases of Laparoscopic distal Panereatectomy with splenectomy(group LDPS).Comparison and analysis of the differences in various clinical indicators and the general situation of the two groups of patients(gender,age,history of abdominal surgery,lesion size and pathological characteristics.),Intraoperative conditions(The amount of bleeding,operation time,etc)and postoperative recovery(Postoperative exhaust time,postoperative eating time,postoperative hospitalization time,complications,incidence of pancreatic fistula,and blood routine and infection index,etc.).The related indicators of perioperative period in the two groups were observed and compared.Retrospective analysis and comparison of the intraoperative and postoperative outcomes of preserving spleen or Spleen Resection for benign and malignant tumors.Result:No statistically significant difference of gender,age,history of abdominal surgery was found between LDP and ODP group(P>0.05);During operation,operative time and intraoperative bleeding in group LSPDP were slightly less than those in group LDPS(234.59± 100.84 vs 255.16±77.43;161.48±149.89 vs 257.5±295.72),but the difference was not statistically significant(P=0.391;P=0.114).The postoperative exhaust time in group LSPDP(1.77±1.20d vs 2.34±1.12d,P=0.065),Postoperative eating time(2.74±1.47d vs 3.49±1.63d,P=0.069),Postoperative hospitalization time(7.70±2.18d vs 9.01±2.94d,P=0.055)all lower than LDPS group,but there was no significant difference in the difference(P>0.05).There was no significant difference in postoperative complications,pancreatic fistula,infection,bleeding,and incidence of pleural effusion and ascites between the two groups(P>0.05).The lesion size of group LSPDP(3.7±2.1cm)obviously less than group LDPS(5.4±3.3cm),P=0.017,Differences are statistically significant(P<0.05).There are 24 cases(24/42,57.14%)did LSPDP in the benign pathology group,and 3 cases(3/17,17.65%)did LSPDP in the pathological malignancy group,P=0.004,The difference is statistically significant(P<0.05).Conclusion:1.Laparoscopic spleen-preserving distal Panereatectomy is safe and feasible.2.Laparoscopic spleen-preserving distal Panereatectomy retained the function of spleen,which is helpful to reduce postoperative thrombotic complications and incidence of infectious complications,and improve postoperative quality of life.3.Laparoscopic spleen-preserving distal Panereatectomy should be considered first while the lesions were benign;For patients with low degree malignancy,less lesion volume,no lymph nodes and distant metastasis,laparoscopic preservation of the spleen and pancreatectomy is also should considered first.Laparoscopic preservation of spleen and distal pancreatectomy is worth popularizing in clinic.