Analysis of the relevant factors of pancreatic fistula after Robot-assisted pancreatic surgery

摘要

Objective To analyze the influence of pancreatic fistula after Robot-assisted pancreatic surgery and the advantages between Robot-assisted pancreatic surgery and traditional open and laparoscopic-assisted pancreatic surgery. Methods The data of 132 cases undergoing Robot-assisted pancreatic surgery were reviewed retrospectively to analyze the curative effect and pancreatic fistula between March 2010 and October 2013 with traditional open and laparoscopic pancreatic surgery,including approaches of pancreaticoduodenectomy,middle pancreatectomy and distal pancreatectomy. Results There were 135 cases of Robot-assisted pancreatic resection. 3 of them were converted to open surgery. 132 cases were successfully completed. 44 patients underwent pancreatoduodenectomy,64 distal pancreatectomy,24 middle pancreatectomy. Among them,the mean surgical time of pancreatoduodenectomy was( 415. 6 ± 114. 0) min and mean blood loss was( 442. 0 ± 281. 9) mL,11 patients required blood transfusion. Pancreatic fistula occurred in 8 cases. The mean hospital stay after surgery was( 23. 2 ± 11. 0) days. The mean surgical time of middle pancreatectomy was 192. 5 ± 52. 0 min and mean blood loss was( 120. 0 ± 105. 8) mL,no patient required blood transfusion. Pancreatic fistula occurred in 9 cases. The mean hospital stay after surgery was( 21. 2 ± 8. 1) days. The mean surgical time of distal pancreatectomy was( 159. 0 ± 84. 3) min and mean blood loss was 221. 3 ± 290. 5 mL,3 patients required blood transfusion. Pancreatic fistula occurred in 18 cases. The mean hospital stay after surgery was( 20. 0 ± 10. 7) days. 46 cases of postoperative complications occurred in Robot-assisted pancreatic surgery. All complications resolved with conservative management except for 4 cases of bleeding,one case of anastomotic rupture,one case of anastomotic block that required a second surgery. Of 44 patients with a postoperative histopathological diagnosis of malignancy, surgical margins were negative in all cases. 88 patients had benign tumors. Conclusions For resectable pancreatic tumors,robot-assisted surgery system can effectively reduce the incidence of pancreatic fistula,hospitalization time and related complications.