| Purpose:A retrospective comparative analysis of the preoperative and intraoperative conditions of two groups of patients with total laparoscopic pancreaticoduodenectomy(TLPD)and open pancreaticoduodenectomy(OPD)And perioperative data such as postoperative efficacy,to further explore the safety and feasibility of TLPD,whether it can obtain minimally invasive advantages like other general laparoscopic surgery and meet the principle of radical tumor.Tumors around the ampulla and other diseases provide a certain reference value.Method:Retrospective analysis of all data before and after treatment of 266 patients undergoing pancreaticoduodenectomy(PD)in the Department of Hepatobiliary Surgery in our hospital from January 2016 to December 2019 Duodenum resection was performed in the TLPD group,and 166 cases of open pancreaticoduodenectomy were performed in the OPD group.Observation indicators:(1)Age,sex ratio,body mass index(BMI),preoperative serum albumin,preoperative total bilirubin,whether preoperative drainage and reduction of yellow,American Society of Anesthesiologists(ASA)classification And the preoperative basic information such as the history of upper abdominal surgery;(2)intraoperative conditions such as operation time,intraoperative blood loss,intraoperative blood transfusion rate and the number of lymph node dissections,lesion diameter,R0 resection rate,tumor nature and other pathological results;(3)Post-hospitalization time,post-operative time for first fluid intake,post-operative analgesic time,post-operative complications(pancreatic leakage,postoperative bleeding,gastric emptying disorder,bile leakage,abdominal infection,etc.),postoperative Severe complications(Clavien-Dindo grade?III)and other postoperative conditions(4)Follow-up and survival.Through statisticalanalysis of the two sets of data,draw conclusions.Result:There was no statistically significant difference between the TLPD group and the OPD group in the observation indexes before surgery.The operation time in the TLPD group was significantly longer than that in the OPD group [(255.8 ± 34.7)min vs.(236.9 ± 34.7)min,p = 0.000],but the intraoperative blood loss was less [(199.9 ±97.7)ml vs.(236.8 ± 123.5)ml,p = 0.011],the intraoperative blood transfusion rate is also lower [7.0% vs.13.9%,p = 0.046],there is no statistically significant difference in intraoperative lymph node dissection,lesion diameter,and R0 resection rate.Postoperative hospital stay in the TLPD group [(16.2 ± 3.7)d vs.(17.5 ± 4.7)d,p = 0.013] and postoperative analgesic time [(3.0 ± 0.9)d vs.(3.3 ± 0.8)d,p = 0.019]were significantly shortened.The time of first meal after operation [(6.7 ± 2.2)d vs.(6.9 ± 2.4)d,p = 0.405] and the difference in the total postoperative complication rate and pathological type distribution between the two groups No statistical significance(p> 0.05).The serious postoperative complications in the two groups were 3 cases and 10 cases,respectively(P = 0.382).For patients with malignant tumors,the 1-year and 3-year survival rates of TLPD and OPD pancreatic cancer patients were not significantly different(86.9% vs.91.5%?28.5% vs.26.8%,P=0.827);periampullary cancer(including twelve The 1-year and 3-year survival rates of papillary adenocarcinoma,common bile duct adenocarcinoma,Fettler's ampulla carcinoma,and duodenal adenocarcinoma were(95.1% vs.93.1%?44.8% vs.42.3%,P=0.401),there was no statistical difference between the two groups.Conclusion:Complete laparoscopic pancreaticoduodenectomy has the same safety and radical tumor effect as open pancreaticoduodenectomy,and shows less intraoperative blood loss and shorter postoperative hospital stay,but surgery It takes longer and has higher technical requirements for the surgeon. |
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