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CLC number: R735.9

On-line Access: 2015-07-03

Received: 2014-09-25

Revision Accepted: 2015-03-12

Crosschecked: 2015-06-16

Cited: 8

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Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Jia-fei Yan

http://orcid.org/0000-0003-4382-3835

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Journal of Zhejiang University SCIENCE B 2015 Vol.16 No.7 P.573-579

http://doi.org/10.1631/jzus.B1400257


Laparoscopic versus open distal pancreatectomy for benign or premalignant pancreatic neoplasms: a two-center comparative study


Author(s):  Jia-fei Yan, Tian-tao Kuang, Da-yong Ji, Xiao-wu Xu, Dan-song Wang, Ren-chao Zhang, Wei-wei Jin, Yi-ping Mou, Wen-hui Lou

Affiliation(s):  Department of General Surgery, Institute of Micro-Invasive Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; more

Corresponding email(s):   mouyiping2002@163.com, lou.wenhui@zs-hospital.sh.cn

Key Words:  Laparoscopy, Distal pancreatic resection, Pancreatic neoplasm, Splenic preservation, Pancreatic benign tumors


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Jia-fei Yan, Tian-tao Kuang, Da-yong Ji, Xiao-wu Xu, Dan-song Wang, Ren-chao Zhang, Wei-wei Jin, Yi-ping Mou, Wen-hui Lou. Laparoscopic versus open distal pancreatectomy for benign or premalignant pancreatic neoplasms: a two-center comparative study[J]. Journal of Zhejiang University Science B, 2015, 16(7): 573-579.

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volume="16",
number="7",
pages="573-579",
year="2015",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1400257"
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%A Xiao-wu Xu
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A1 - Xiao-wu Xu
A1 - Dan-song Wang
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Abstract: 
Objective: To compare the peri-operative outcomes for laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for benign or premalignant pancreatic neoplasms in two institutions. Methods: This prospective comparative study included 91 consecutive patients who underwent LDP (n=45) or ODP (n=46) from Jan. 2010 to Dec. 2012. Demographics, intra-operative characteristics, and post-operative outcomes were compared. Results: The median operating time in the LDP group was (158.7±38.3) min compared with (92.2±24.1) min in the ODP group (P<0.001). Patients had lower blood loss in LDP than in the ODP ((122.6±61.1) ml vs. (203.1±84.8) ml, P<0.001). The rates of splenic conservation between the LDP and ODP groups were similar (53.3% vs. 47.8%, P=0.35). All spleen-preserving distal pancreatectomies were conducted with vessel preservation. LDP also demonstrated better post-operative outcomes. The time to oral intake and normal daily activities was faster in the LDP group than in the ODP group ((1.6±0.5) d vs. (3.2±0.7) d, P<0.01; (1.8±0.4) d vs. (2.1±0.6) d, P=0.02, respectively), and the post-operative length of hospital stay in LDP was shorter than that in ODP ((7.9±3.8) d vs. (11.9±5.8) d, P=0.006). No difference in tumor size ((4.7±3.2) cm vs. (4.5±1.8) cm, P=0.77) or overall pancreatic fistula rate (15.6% vs. 19.6%, P=0.62) was found between the groups, while the overall post-operative complication rate was lower in the LDP group (26.7% vs. 47.8%, P=0.04). Conclusions: LDP is safe and effective for benign or premalignant pancreatic neoplasms, featuring lower blood loss and substantially faster recovery.

腹腔镜与开腹胰体尾切除术双中心对照研究

目的:评估腹腔镜胰体尾切除术安全有效性,对比腹腔镜胰体尾切除术与开腹胰体尾切除术治疗胰腺体尾部良性或低度恶性病变临床疗效。
创新点:本研究为回顾性对照研究,相较于过往腹腔镜胰体尾切除术与开腹胰体尾切除术的对照研究,其创新点一为本组91例病例均为良性或低度恶性病例,剔除了恶性病变病例;二为本研究中腹腔镜胰体尾切除术组及开腹胰体尾切除术组分别由两家大型综合医院胰腺疾病诊治中心的两组医生分别施行手术,这样避免了病人及手术方式选择等造成的影响,结果更为客观。
方法:回顾分析自2010年1月至2012年12月浙江大学医学院附属邵逸夫医院45例施行腹腔镜胰体尾切除术治疗胰腺体尾部良性或低度恶性病变病例(LDP组),以及同期上海复旦大学附属中山医院46例施行开腹胰体尾切除术胰腺体尾部良性或低度恶性病变病例(ODP组)的相关临床资料,进行对照研究。
结论:本研究包括胰腺体尾部良性或低度恶性病例91例,其中LDP组45例(无中转开腹)和ODP组46例。手术时间分别为(158.7±38.3)min(LDP组)和(92.2±24.1)min(ODP组);术中出血LDP组明显少于ODP组((122.6±61.1)ml vs. (203.1±84.8)ml,P<0.001)。两组保脾率相似(53.3% vs. 47.8%,P=0.35),其中LDP组中保脾病例均保留脾血管。在术后恢复指标方面,LDP组优于ODP组,恢复进食流质时间((1.6±0.5)d vs. (3.2±0.7)d,P<0.01)及恢复活动时间((1.8±0.4)d vs. (2.1±0.6)d,P=0.02)较短,且LDP组术后住院时间也少于ODP组((7.9±3.8)d vs. (11.9±5.8)d,P=0.006)。术后胰瘘率两组无明显差异(15.6% vs. 19.6%,P=0.62),但术中总并发症率LDP组低于ODP组(26.7% vs. 47.8%,P=0.04)。研究结果显示腹腔镜胰体尾切除术治疗胰腺体尾部良性或低度恶性肿瘤安全可行,与开腹胰体尾切除术术相比术中出血更少、术后恢复更快,具有明显微创优势。

关键词:胰腺肿瘤;腹腔镜;胰体尾切除术

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

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