Analysis of Clinical efficacy、serum indexes and prognosis of laparoscopic total mesopancreas excision in the treatment of pancreatic head carcinoma patients

Abstract

Objective To investigate the effect of laparoscopic total mesorectal excision on pancreatic head carcinoma and its influence on serum index and prognosis. Methods A retrospective study was performed on 80 cases of patients with pancreatic head carcinoma who were admitted from August 2015 to March 2018.According to different surgical methods, the patients were divided into laparoscopic group and laparotomy group, with 40 patients in each group.In the laparoscopic group, there were 26 males and 14 females.The patients were(52.8±9.0) years old and ranged from 42 to 67 years old and underwent laparoscopic total mesorectal excision.In the laparotomy group, there were 25 males and 15 females.The patients were(53.0±7.5) years old, ranging from 43 to 65 years old, and underwent open pancreatoduodenectomy.Perioperative indicators(operative time, intraoperative blood loss, length of hospital stay and postoperative anal exhaust time), serum indicators[CA 19-9, 1, 25-dihydroxyvitamin D3 and microRNA-21], postoperative complications and 1-year survival rate were compared between the two groups. Results In the laparoscopic group, the resection rate[87.5%(35/40)]was higher than the laparotomy group[70.0%(28/40)], the operation time[(6.0±1.5) h]was longer than the laparotomy group[(4.3 ± 1.1) h], the intraobleeding volume[(621.3±90.0) ml]was lower than the laparotomy group[(720.8 ± 110.3) ml], the hospitalization time[(9.8±2.0) d], the postoperative anal exhaust time[(2.8±1.4) d]were shorter than the open group[(12.5±2.5) d, (3.6±1.2.2) d], and the difference was statistically significant(P<0.05). The relative expression of CA19-9[(68.1±5.3) U/ml]and microRNA-21(3.22±0.53) in laparoscopy group was lower than that in laparotomy group[(88.7±8.0) U/ml), (3.98±0.60)], 1, 25-dihydroxyvitamin D3[(31.3±3.1) pg/ml]was higher than that in laparotomy group[(25.8±2.6) pg/ml], (P<0.05). The postoperative complication rate of laparoscopic group[15%(6/40)]was lower than that of laparotomy group[35.0%(14/40)], and the 1-year survival rate[65.0%(25/40)]was higher than that of open group[27.5%(11/40)], (P<0.05). Conclusion Laparoscopic total mesorectal excision of the pancreas is more effective in patients with pancreatic head carcinoma, and can reduce the incidence of postoperative complications and improve the short-term prognosis of patients, which is worthy of clinical promotion. Key words: Pancreatic head carcinoma; Total mesorectal excision; Pancreaticoduodenectomy; Serum indexes; Prognosis