| Objective:Comparative analysis of laparoscopic resection of pancreatic duodenal pancreatic duodenal resection in the treatment of pancreatic cancer and laparotomy and ampulla around tumor curative effect.Methods:A retrospective analysis was performed on 108 patients who underwent pancreaticoduodenectomy from January 2017 to December2019.They were divided into LPD group and OPD group according to surgical methods.13 patients with benign pathological diagnosis and 4patients with conversion to laparotomy were excluded,including 91patients,35 patients in LPD group and 56 patients in OPD group.Results:There were 35 patients in the LPD group,including 18 males and17 females,aged 58.83±8.64 years,BMI 22.55±2.91 Kg/m~2.There were 56 patients in the OPD group,including 35 males and 21 females,aged 61.05±9.24 years,BMI 22.03±3.02 Kg/m~2.Preoperative ASA score,LPD groupⅠlevel 10 cases,Ⅱlevel 13 cases,Ⅲlevel 12cases;OPD groupⅠlevel 7 cases,Ⅱlevel 23 cases,Ⅲlevel 26cases.Preoperative data(including gender,age,ASA score and BMI)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(529.29±95.94)min vs.OPD group(320.71±78.93)min,P<0.001;Intraoperative blood transfusion volume:LPD group(487.5±158.64)ml vs.OPD(588.89±272.22)ml,P=0.131;Postoperative exhaust time:LPD group(5.11±2.75),d vs.OPD group(6.36±3.62)d,P=0.085;Postoperative feeding time:LPD group(8.74±2.95)d vs.OPD group(12.36±5.08)d,P<0.001;Pull out gastric tube time:LPD group(6.66±2.57)d vs.OPD group(7.98±3.15)d,P=0.040;Pull out abdominal drainage tube time:LPD group(16.91±6.43)d vs.OPD group(20.16±8.63)d,P=0.059;Postoperative hospital stay:LPD group(21.57±7.83)d vs.OPD group(23.95±17.23)d,P=0.446;Number of lymph nodes resected:LPD group(11.74±6.38)group vs.OPD group(14.91±8.7)group,P=0.067;Positive lymph node number:LPD group(0.77±1.06)group vs.OPD group(0.81±1.3)group,P=0.870;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,incision infection or fat liquefaction,pleural effusion and peritoneal effusion.R0 resection was achieved in both groups,and no perioperative death was observed.Conclusions:1、LPD is still a complicated operation in abdominal surgery with a long learning curve.Although the operation time of LPD is longer,the time of feeding and gastric tube removal after operation is earlier,and there is no significant difference in postoperative complications and number of lymph nodes resected between LPD and OPD.Generally speaking,LPD is safe and effective.2、Because it is at the beginning of the learning curve,the intraoperative blood loss,postoperative exhaust time and postoperative hospital stay in OPD,group are not better than those in LPD group,which is slightly less than that in OPD group.It is believed that with the increase of the number of cases,the improvement of team experience,the optimization of surgical process and the improvement of instruments and equipment,it is believed that the advantages of LPD will be gradually reflected.3、The short-term clinical effect of LPD is at least as good as that of OPD,in experienced large medical centers. |
