Analysis of short-term prognosis and risk for conversion to laparotomy in laparoscopic pancreaticoduodenectomy
10.3760/cma.j.cn115396-20240509-00136
- VernacularTitle:腹腔镜胰十二指肠切除术中转开腹对近期预后的影响及风险分析
- Author:
Yang XU
1
;
Wei GUO
;
Yanjing LI
;
Jiaping WEI
;
Chao JING
Author Information
1. 首都医科大学附属北京友谊医院普通外科中心，北京 100050
- Keywords:
Pancreaticoduodenectomy;
Laparoscopic surgery;
Retrospective studies;
Risk assessment;
Postoperative complications
- From:
International Journal of Surgery
2024;51(10):687-693
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the perioperative conditions of open pancreaticoduodenectomy (OPD), laparoscopic pancreaticoduodenectomy (LPD) and LPD conversion OPD, and analyze the short-term prognosis and risk factors for LPD conversion OPD.Methods:The clinical data of 167 patients undergoing pancreaticoduodenectomy (PD) in the Beijing Friendship Hospital, Capital Medical University from February 2020 to March 2023 were retrospectively analyzed. Of 167 patients, 63 patients underwent OPD surgery (OPD group), 91 patients underwent LPD surgery (LPD group), and 13 patients were converted to OPD during LPD surgery (LPD conversion OPD group). The measurement data with non-normal distribution were expressed as median (interquartile range) [ M( Q1, Q3)], and comparison between groups was analyzed using the Kruskal-Wallis H test. The count data were expressed as the number of cases and percentage, and the Chi-square test was used for ordered categorical variable, Kruskal-Wallis H test was used for un-ordered categorical variable. The risk factors of LPD conversion OPD were analyzed by multivariate Logistic regression. Results:The intraoperative blood loss [600(350, 1 000) mL], bilio-intestinal drainage stay time [10(8, 15) d] and bilio-intestinal drainage volume [995(505, 1 502) mL] in the LPD conversion OPD group were significantly higher than those in the LPD group [200(100, 300) mL, 7(6, 6) 10) d, 450(175, 874) mL], the differences were statistically significant ( P<0.05). The operation time of the LPD conversion OPD group [335(293, 385) d] was significantly longer than that of the OPD group [230 (195, 290)d], and the difference was statistically significant ( P<0.05). Multivariate Logistic regression analysis revealed that preoperative complications of chronic pancreatitis ( OR=19.714) and maximum diameter of the lesion ( OR=5.583) has a significant impact on the LPD conversion OPD ( P<0.05). Conclusions:Patients who plan to undergo PD should prefer LPD if the technology and physical condition permit. Preoperative complication of chronic pancreatitis, maximum diameter of lesion > 3.5 cm are the risk factors for LPD conversion OPD, which may significantly increase intraoperative blood loss, prolong the indwelling time of biliary drainage tube, and increase the drainage volume of biliary drainage tube. Therefore, the surgical method should be carefully selected.
