Objective: To compare the perioperative outcomes of laparoscopic duodenal-preserving pancreatic head resection(LDPPHR) with laparoscopic pancreaticoduodenectomy(LPD) in the treatment of borderline and benign diseases of the pancreatic head. Methods: This is a retrospective cohort study. Perioperative data from 87 patients with non-malignant pancreatic head diseases who underwent LDPPHR or LPD were retrospectively collected in the Department of Biliary-Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2020 to December 2022. There were 49 male and 38 female patients with an age (M(IQR)) of 57.0(16.5) years (range: 20 to 75 years). Forty patients underwent LDPPHR and 47 patients underwent LPD. Quantitative data following a normal distribution were compared using Student's t-test, while quantitative data not following a normal distribution were compared using the Mann-Whitney U test. Comparisons of categorical or ordinal variables were made using χ2 test or Fisher's exact test. Logistic regression analysis was used to estimate the risk factors associated with the rate of complications. Results: There were no statistically significant differences between the LDPPHR group and the LPD group in terms of reoperation rate,total hospital stay duration,postoperative hospital stay duration,90-day mortality rate,30-day and 90-day readmission rates,and 2-year tumor recurrence rate (all P>0.05). The complication rate was higher in the LDPPHR group compared to the LPD group (80.0%(32/40) vs. 51.1%(24/47), χ2=7.89,P=0.005),but there was no difference in the rate of Clavien-Dindo classification of surgical complications ≥Ⅲ between the two groups (10.0%(4/40) vs. 12.8%(6/47), χ2<0.01, P=0.947). Additionally,the rate of delayed gastric emptying (DGE) was higher in the LDPPHR group compared to the LPD group (χ2=10.79,P=0.001),but there was no statistically significant difference in the rate of B,C grade DGE between the two groups (χ2=0.48, P=0.487). There were no statistically significant differences in the rates of postoperative pancreatic fistula,bile leakage,post-pancreatectomy hemorrhage,intra-abdominal infection,and pulmonary infection between the two groups (all P>0.05). The results of the univariate logistic regression analysis showed that LDPPHR (compared to LPD, OR=3.83, 95%CI: 1.46 to 10.04, Z=2.73,P=0.006) and preoperative biliary stent placement (compared to non-use of biliary stent, OR=5.30, 95%CI: 1.13 to 25.00, Z=2.11, P=0.035) were risk factors for the complication rate,but neither was an independent risk factor for complication rate (all P>0.05). Conclusion: The preliminary results suggest that LDPPHR can achieve perioperative safety and effectiveness comparable to LPD.
目的： 比较腹腔镜保留十二指肠的胰头切除术（LDPPHR）与腹腔镜胰十二指肠切除术（LPD）治疗胰头交界性肿瘤及良性疾病的围手术期效果。 方法： 本研究为回顾性队列研究。回顾性收集2020年1月至2022年12月华中科技大学同济医学院附属同济医院胆胰外科通过LDPPHR或LPD治疗的87例胰头交界性肿瘤及良性疾病患者的围手术期资料。男性49例，女性38例，年龄［M（IQR）］57.0（16.5）岁（范围：20~75岁）。其中40例接受LDPPHR，47例接受LPD。正态分布的定量资料采用Student′s t检验进行比较，非正态分布的定量资料采用Mann-Whitney U检验进行比较，分类变量的比较采用χ2检验或Fisher确切概率法。使用Logistic回归分析估计与并发症发生相关的危险因素。 结果： LDPPHR组和LPD组患者的再手术率、总住院时间、术后住院时间、90 d病死率、30 d及90 d再入院率和2年肿瘤复发率的差异均无统计学意义（P值均>0.05）。LDPPHR组的围手术期并发症发生率高于LPD组［80.0%（32/40）比51.1%（24/47）；χ2=7.89，P=0.005］，但两组Clavien-Dindo并发症分级系统≥Ⅲ级并发症发生率的差异无统计学意义［10.0%（4/40）比12.8%（6/47）；χ2<0.01，P=0.947］。LDPPHR组患者的胃排空延迟（DGE）发生率高于LPD组（χ2=10.79，P=0.001），但两组B、C级DGE发生率的差异无统计学意义（χ2=0.48，P=0.487）。在术后胰瘘、胆瘘、胰腺术后出血、腹腔感染、肺部感染等并发症发生率方面，两组差异均无统计学意义（P值均>0.05）。单因素Logistic回归分析结果表明，LDPPHR（参照LPD，OR=3.83，95%CI：1.46~10.04，Z=2.73，P=0.006）和术前胆管支架置入（参照不使用胆管支架，OR=5.30，95%CI：1.13~25.00，Z=2.11，P=0.035）是总体并发症发生的危险因素，但两者均不是总体并发症发生的独立危险因素（P值均>0.05）。 结论： 初步研究结果显示，在治疗胰头交界性及良性疾病方面，LDPPHR可获得与LPD相当的围手术期安全性和有效性。.