To explore the clinical effect of different surgical paths in laparoscopic pancreatoduodenectomy（LPD）.

Retrospective analysis was performed on the clinical data of 80 patients who received LPD from January 2017 to October 2021. All patients received the superior mesenteric artery（SMA）as the central artery approach to complete the operation，and were divided into observation group（n=39 cases）and control group（n=41 cases）according to different surgical routes. The observation group received the anteriormiddle approach combined with the left posterior approach. The control group was treated by conventional right approach. SPSS 21.0 statistical software was used to complete data analysis，and the count of postoperative complications was compared between the data groups for χ² test. Measurement data such as perioperative indicators were represented by（mean ± standard deviation），and t test was used for comparison between groups. Kaplan-Meier survival curve was used to analyze the prognosis of the two groups. P<0.05 indicated statistically significant differences.

The operation time and specimen removal time in observation group were longer than those in control group，and the indexes of intraoperative blood loss，number of lymph nodes detected and postoperative hospital stay were better than those in control group（P<0.05）. The total incidence of postoperative complications in observation group was significantly lower than that in control group（P<0.05）. There was no significant difference in cumulative disease-free survival and cumulative overall survival between the two groups（Log-Rank χ²=0.874，P=0.350；χ²=0.553，P=0.457）.

Compared with the traditional right SMA approach，the anterior middle approach combined with the left posterior approach lengthens the operation time，but it is a safe and feasible surgical approach with more thorough dissection of operative lymph nodes，more beneficial to vascular protection and less postoperative complications by exposing the operative field from multiple angles.