| Objective:Based on the perioperative clinical data of 74 cases of laparoscopic spleen-preserving resection of body and tail of pancreas,we would like to compare the clinical effects of spleen-preserving resection of body and tail of pancreas with or without preservation of splenic vessels（Kimura procedure and Warshaw procedure）in the treatment of diseases of body and tail of pancreas.Methlds:The perioperative data of 74 patients who underwent spleen-preserving pancreatectomy（33 cases of Kimura procedure,41 cases of Warshaw procedure）in the Department of Hepatobiliary and Pancreatic surgery of the first Hospital of Jilin University from January 2019 to October 2021 were analyzed retrospectively.The data were divided into preoperative data,intraoperative data,postoperative data and pathological data.Follow-up by means of outpatient follow-up and telephone follow-up.The data were statistically analyzed by SPSS software 23.0 version: the measurement data were tested first by normality test,normally distributed data are expressed as mean ± standard deviation,Otherwise,medians（quartiles）were used.Two groups of data were compared using t-test or nonparametric test.The counting data were expressed by the number of cases（percentage）,if the chi-square test was not met,Fisher’s exact test was used,and the ordinal grade data was used nonparametric test.Univariate analysis was performed with Logistic regression.P <0.05 was considered statistically significant.Results:The operation time of Kimura group and Warshaw group was（149.52±39.59）min and（124.83±38.58）min respectively（P<0.05）,and the intraoperative blood loss was 65（45-107）ml and 65（35-150）ml respectively（P>0.05）.The postoperative intestinal exhaust time in the Kimura group and Warshaw group was（2.30±0.73）d and（2.34±0.85）d respectively（P>0.05）,and the postoperative hospital stay was（6.39±1.78）d and（6.12±1.65）d respectively.（P>0.05）,the total hospitalization cost was（70823.77±14230.92）yuan and（71012.26±12856.87）yuan respectively（P>0.05）,the platelet count one month after the operation was（219±61）×109/L and（211±87）×109/L respectively（P>0.05）,fasting blood glucose one month after operation was（7.57±2.52）mmol/L and（6.95±1.85）mmol/L respectively（P>0.05）.In the Kimura group,there were 7 cases of biochemical leak 、 3 cases of grade B pancreatic fistula,no grade C pancreatic fistula,2 cases of postoperative pseudocyst,5 cases of splenic vein thrombosis,2 cases of splenomegaly.There were no complications of abdominal infection,splenic infarction and gastric varices.In the Warshaw group,there were 8cases of biochemical leak,4 cases of grade B pancreatic fistula,no grade C pancreatic fistula,1 case of postoperative pseudocyst,3 cases of abdominal infection,11 cases of splenic infarction,1 case of splenic vein thrombosis,7 cases of gastric varices and 6cases of splenomegaly.There were no significant differences in postoperative complications between the two groups,such as pancreatic fistula,pancreatic pseudocyst formation,abdominal infection,splenic vein thrombosis,and splenomegaly（P>0.05）.Spleen infarction and gastric varices were more likely to occur in the Warshaw group than in the Kimura group（P<0.05）.Five of the six patients with splenomegaly in the Warshaw group had gastric varices,and patients with gastric varices had a higher risk of developing splenomegaly than those without gastric varices（OR:53.333,95 %ci: 7.165 ～ 396.998,P<0.05）.There was no significant difference in the preoperative and postoperative platelet counts between the two groups（P>0.05）.The postoperative fasting blood glucose values ??in the two groups were higher than the preoperative fasting blood glucose values??（P<0.05）.Conclusion:1.The two surgical methods are both safe and effective in the treatment of benign,borderline or mildly malignant tumors of the body and tail of the pancreas.2.Compared with the Kimura method,although the Warshaw method is less difficult to operate,the incidence of asymptomatic splenic infarction and gastric varices is higher.Kimura is the first choice for experienced surgeons.When the tumor is large or close to the splenic vessels,Warshaw is another safe and effective method to protect the spleen.3.Compared with preoperative,splenomegaly after LSPDP is associated with gastric varices,and patients with gastric varices have a higher risk of developing splenomegaly than those without gastric varices. |
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