文章：

与腹腔镜技术相比，机器人辅助远端胰腺切除术具有更优的临床结果：单外科医生连续123例手术经验总结

Robotic Distal Pancreatectomy Yields Superior Outcomes Compared to Laparoscopic Technique: A Single Surgeon Experience of 123 Consecutive Cases

原文发布日期：20 November 2023

DOI: 10.3390/cancers15225492

类型: Article

开放获取: 是

英文摘要：

Technical limitations of laparoscopic distal pancreatectomy (LDP), in comparison to robotic distal pancreatectomy (RDP), may translate to high conversion rates and morbidity. LDP and RDP procedures performed between December 2008 and January 2023 in our tertiary referral hepatobiliary and pancreatic centres were analysed and compared with regard to short-term outcomes. A total of 62 consecutive LDP cases and 61 RDP cases were performed. There was more conversion to open surgeries in the laparoscopic group compared with the robotic group (21.0% vs. 1.6%,p= 0.001). The LDP group also had a higher rate of postoperative complications (43.5% vs. 23.0%,p= 0.005). However, there was no significant difference between the two groups in terms of major complication or pancreatic fistular after operations (p= 0.20 andp= 0.71, respectively). For planned spleen-preserving operations, the RDP group had a shorter mean operative time (147 min vs. 194 min,p= 0.015) and a reduced total length of hospital stay compared with the LDP group (4 days vs. 7 days,p= 0.0002). The failure rate for spleen preservation was 0% in RDP and 20% (n = 5/25) in the LDP group (p= 0.009). RDP offered a better method for splenic preservation with Kimura’s technique compared with LDP to avoid the risk of splenic infarction and gastric varices related to ligation and division of splenic pedicles. RDP should be the standard operation for the resection of pancreatic tumours at the body and tail of the pancreas without involving the celiac axis or common hepatic artery.

摘要翻译： 

与机器人辅助远端胰腺切除术（RDP）相比，腹腔镜远端胰腺切除术（LDP）的技术局限性可能导致较高的中转开腹率和并发症发生率。本研究对2008年12月至2023年1月期间在我院肝胆胰中心连续实施的LDP与RDP病例进行对比分析，重点关注围手术期结局。共纳入62例LDP和61例RDP病例。腹腔镜组中转开腹率显著高于机器人组（21.0% vs. 1.6%，p=0.001），术后总体并发症发生率也更高（43.5% vs. 23.0%，p=0.005）。但两组在严重并发症（p=0.20）及术后胰瘘发生率（p=0.71）方面无显著差异。在计划性保脾手术中，RDP组平均手术时间更短（147分钟 vs. 194分钟，p=0.015），住院总时长更少（4天 vs. 7天，p=0.0002）。保脾失败率在RDP组为0%，LDP组达20%（5/25例，p=0.009）。采用木村法保脾时，RDP较LDP能更有效避免脾蒂结扎离断相关的脾梗死及胃底静脉曲张风险。对于未累及腹腔干或肝总动脉的胰体尾部肿瘤切除，RDP应作为标准术式。

原文链接：

Robotic Distal Pancreatectomy Yields Superior Outcomes Compared to Laparoscopic Technique: A Single Surgeon Experience of 123 Consecutive Cases