对比研究腹腔镜胰体尾切除术(LDP)与开腹胰体尾切除术(DP)的临床效果。

回顾性分析2015年1月至2019年12月行胰体尾切除术患者80例临床资料，2015年1月至2018年1月行开腹DP的46例患者为开腹组，2018年2月至2019年12月行LDP并进行围手术期ERAS管理的34例患者设为腹腔镜组。临床数据分析使用SPSS 24.0，围手术期相关指标、血清应激指标等计量资料采用(±s)表示，采用独立t检验；术后并发症发生率及并发症严重程度Clavien-Dindo评分采用χ²检验，等级计数资料采用秩和检验。P<0.05差异有统计学意义。

腹腔镜组术后首次排气时间、首次排便时间、下床活动时间、术后住院时间、导尿管拔除时间及腹腔引流管拔除时间均较开腹组更短(P<0.05)。腹腔镜组术后并发症发生率17.5%低于开腹组35.0%，腹腔镜组Clavien-Dindo评分较开腹组轻，但两组间差异无统计学意义(P>0.05)。比较两组患者不同时间点TNF-α、CRP及IL-6水平变化，时间与方法在TNF-α、CRP及IL-6均存在交互作用(P<0.05)，方法在TNF-α、CRP及IL-6上主效应均显著(P<0.05)，时间在TNF-α、CRP及IL-6上主效应均显著(P<0.05)。两组患者术前TNF-α|、CRP及IL-6水平相近(P>0.05)，术后1 d、3 d三项指标水平明显升高(P<0.05)，腹腔镜组的TNF-α、CRP及IL-6水平均优于开腹组(P<0.05)。

相较于开腹胰体尾切除术，LDP结合ERAS围手术期管理，可有效减轻患者应激水平，降低并发症的发生率，对患者术后快速康复有积极的促进作用。

To compare the clinical outcome of laparoscopic and open distal pancreatectomy.

From January 2015 to December 2019, clinical data of 80 patients who underwent pancreatectomy were analyzed retrospectively. From January 2015 to January 2018, 46 patients underwent open distal pancreatectomy were divided into the open group, while from February 2018 to December 2019, 34 patients underwent laparoscopic distal pancreatectomy with perioperative ERAS management were divided into the laparoscopic group. Statistical software SPSS24.0 were used for data analysis. Measurement data such as Perioperative indexes、serum stress indexes were expressed as (±s), and were examined by using independent t test; Chi-square test was performed for the postoperative complication rate and severity of postoperative complications , and rank sum test was used for grade count data. A P value of <0.05 was considered as statistically significant.

In terms of the first exhaust time, first defecation time, ambulation time, postoperative hospitalization time, catheter removal time and abdominal drainage tube removal time in Laparoscopic group were significant shorter than those in the conventional group respectively (P<0.05). The incidence of postoperative complications of 17.5% in the Laparoscopic group was lower than 35.0% in the conventional group . The Clavien-Dindo score in laparoscopic group was lower than that in open group, however with no significant difference (P>0.05). To compare two group in terms of TNF-α, CRP and IL-6 level at different time points, there were significant interaction in TNF-α, CRP and IL-6 by method and time (P<0.05), main effects of time and method were significant in terms of TNF-α, CRP and IL-6 (P<0.05). There was no significant difference of the levels of TNF-α, CRP and IL-6 between the two groups before operation (P>0.05); the levels of TNF-α, CRP and IL-6 were significantly increased at 1 day and 3 days after operation (P<0.05); the levels of TNF-α, CRP and IL-6 in Laparoscopic group were better than those in conventional group (P<0.05).

Compared with open distal pancreatectomy, laparoscopic distal pancreatectomy combined with ERAS perioperative management could effectively reduce the stress level of patients with decreased incidence of complications and enhanced recovery of patients.