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복강경 비장보존 원위췌절제술과 복강경 원위췌비장절제술의 비교
강성화(Sung Hwa kang),박관태(Kwan Tae Park),김영훈(Young Hoon Kim),서혜련(Hye Ryun Seo),한덕종(Duck Jong Han),김송철(Song Chul Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4
Purpose: The purpose of this study is to compare the clinical results of spleen preserving laparoscopic distal pancreatectomy (SPLDP) with en bloc laparoscopic distal pancreatectomy (LDP). Methods: From March 2005 to August 2008, 52 cases of SPLDP and 84 LDPs were performed at our institution and we retrospectively compared these cases. The enrollment period were chronologically divided to four eras of 10.5 months each. Results: The demographics, including the patients’ age, gender and BMI, were not different between the two groups. The final pathologic diagnosis was diverse, and it included cystic tumor, SPT, IPMT, cancer, endocrine tumor, etc and there was no difference between the two groups. The tumor location, operative time, tumor size, perioperative transfusion requirement, the length of the hospital stay and the postoperative complications were not different between the two groups. The mean operative time was gradually shortened by eras (Era 1: 236.3 min, Era 2: 223.6 min, Era 3: 188.8 min, Era 4: 187.9 min) and the proportion of SPLDP was increased by eras from 1.9% to 9.6%, 42.3% and 46.2%, respectively. Conclusion: SPLDP might be technically more difficult than LDP, and especially in the initial learning stage of performing laparoscopic pancreatic surgery. After overcoming the learning curve, SPLDP can be performed safely and possibly within a shorter time. SPLDP should be tried whenever possible so that the patients get the maximal benefits of minimal invasive surgery and especially for resecting the more distal pancreatic lesions.
최근 5년간 시행된 췌십이지장절제술의 합병증에 대한 임상적 고찰
전상훈(Sang Hoon Jeon),박관태(Kwan Tae Park),장혁재(Hyuk Jai Jang),김영훈(Young Hoon Kim),한덕종(Duck Jong Han),김송철(Song Chul Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4
Purpose: Pancreaticoduodenectomy (PD) is known to have high morbidity and mortality rates among the various abdominal operations, but there have been few reported current series of pancreaticoduodenectomy from large volume medical centers. The purpose of this study is to analyze the postoperative complications of PD and to assess the risk factors for postoperative morbidity. Methods: A total of 398 cases of PD were performed by two surgeons from January 2003 to December 2007 at our institution and we retrospectively reviewed the medical records of these cases. Results: 186 (46.7%) of 398 patients underwent pylorus preserving pancreaticoduodenectomy (PPPD) and 212 patients (53.3%) underwent a classic Whipple procedure. The most common indication for this procedure was pancreatic cancer (151 cases, 37.9%) and the second most common was intraductal papillary mucinous tumor (78 cases, 19.6%). The mean age was 57.2 years, ranging from 12 to 81. The mean postoperative hospital stay was 24.7 days. The most common complication was delayed gastric emptying (11.8%) and next was pancreatic fistula (10.3%), bleeding (6.5%) and new onset diabetes mellitus (DM) (4%). Four patients (1%) died of hospital mortality. The patients’ age, gender, DM history, hypertension history and serum bilirubin level had no significant influences on the postoperative morbidity rate. Conclusions: Pancreaticoduodenectomy can be performed safely with an acceptable complication rate and minimal mortality if the surgeon has sufficient surgical experiences and with the advance in anesthesia and postoperative care.