Comparative Analysis Of The Clinical Efficacy Of Laparoscopic And Open Distal Pancreatectomy

Objective:By comparing the short-term clinical curative effect and prognosis for survival in patients with benign and malignant disease of LDP and ODP,including the preoperative clinical data of postoperative complications and prognosis of survival situation.analysing the clinical curative effect of LDP and ODP,summarized the our department experience of LDP.Methods:The clinical data of 168 patients undergoing distal pancreatectomy in the Department of Hepatobiliary Surgery,East Hospital of Provincial Hospital from July 2015 to June 2020 were collected.The intraoperative situation,postoperative hospitalization recovery,complications and prognosis of patients with benign and malignant pancreatic diseases were compared between LDP and ODP.SPSS.25 statistical software was used for data analysis to determine whether there were statistical differences.ResultsOperative indicators:both groups completed the resection of the DP,and the cases transferred by LDP were classified into the ODP.Compared with the ODP,the total number of hospital days,postoperative hospital days and postoperative diet abstinence time in the LDP were shortened(P<0.05),and there was no statistical difference of the operation time,intraoperative red blood cell infusion,plasma between the LDP and ODP(P<0.05).Perioperative complications,there was no perioperative death in both groups,including the incidence of pancreatic fistula,postoperative abdominal infection and other complications in the two groups was not statistically significant(P>0.05).A comparative study was conducted on the intraoperative situation and postoperative recovery of LSPDP and LDPS cases with benign pancreatic disease.the operation time,the rest of the diet prohibition time,complications,etc.showed no statistical difference between the two groups(P>0.05).In terms of postoperative survival time,patients diagnosed as malignant tumor after surgery were followed up,median survival time and quartile survival time were compared between the LDP and ODP,and univariate survival analysis and Cox proportional hazard analysis were performed.The results showed that there was no statistically significant difference in postoperative survival between the LDP and ODP(P>0.05).Conclusion:In this study,the short-term efficacy and postoperative complications of LDP group and ODP group were compared in groups of DP benign diseases and malignant tumors.There were no statistically significant differences in intraoperative blood loss and operative time between the two groups of patients with the two types of diseases.The LDP group was superior to the ODP group in shortening the total length of hospital stay,postoperative hospital stay,postoperative diet abstinence,etc.,and there was no statistical difference in postoperative complications such as postoperative pancreatic fistula and infection between the two groups.There was no statistically significant difference in postoperative overall survival between the two groups in malignant tumor cases.It shows that the LDP method is safe,equivalent and minimally invasive.For benign and low-grade malignant pancreatic diseases,LDP was the first choice,according to the previous literature.In terms of LSPDP and LDPS,intraoperative and postoperative conditions of LSPDP for benign diseases and LDPS group were compared.The hospitalization days after LSPDP were shorter than those of LDPS group.For benign pancreatic diseases,the spleen should be kept as much as possible.For PDAC and other malignant tumors,in line with the principle of radical treatment,combined splenectomy can be.In LSPDP,Kimura is preferred.However,it is difficult to perform this operation.If it is difficult to expose and free the splenic artery and vein during the operation,Warshaw can be considered and when the splenic blood supply problem occurs,the preservation of the spleen can be decisively abandoned.Pancreatic fistula is the most common complication of pancreatic surgery,and there are many influencing factors.The incidence of pancreatic fistula can be reduced by using a closure device and covering and fixing the broken end of the pancreas with the round ligament of the live or the omentumr.