中国普外基础与临床杂志

中国普外基础与临床杂志

腹腔镜保留脾脏胰体尾切除术的临床研究

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目的 探讨腹腔镜保留脾脏胰体尾切除术的可行性及临床价值。 方法 回顾性分析 2015 年 1 月至 2017 年 6 月期间 17 例施行腹腔镜保留脾脏胰体尾切除术患者的临床资料。 结果 17 例患者均在腹腔镜下完成保留脾脏胰体尾切除术,按 Kimura 法完成 12 例,按 Warshaw 法完成 5 例。全组患者手术时间为(218±60)min,术中出血量为(136±114)mL,术后开始下床活动时间为(1.4±0.6)d,术后首次进流食时间为(2.0±0.8)d,术后住院时间为(13±6)d。术后发生生化漏 3 例,B 级胰瘘 3 例(17.6%)。术后发生脾局灶性梗死 2 例。术后病理:胰腺浆液性囊腺瘤 2 例,黏液性囊腺瘤 7 例,实性假乳头状瘤 3 例,导管内乳头状黏液性肿瘤 3 例,胰岛素瘤 2 例。术后随访 5~26 个月,无肿瘤复发,未发现脾梗死,发现胃周静脉曲张 1 例,但未破裂出血。 结论 腹腔镜保留脾脏胰体尾切除术安全、可行、创伤小及恢复快。

Objective To evaluate feasibility and clinical application value of laparoscopic spleen-preserving distal pancreatectomy (LSPDP). Method The clinical data of 17 patients underwent LSPDP from January 2015 to June 2017 in this hospital were retrospectively analyzed. Results The LSPDP was successfully completed in the 17 cases, with Kimura procedure or with Warshaw procedure was performed in the 12 cases and 5 cases, respectively. The operation time was (218±60) min, the intraoperative blood loss was (136±114) mL, the time to get out of bed after surgery was (1.4±0.6) d, the postoperative fasting time was (2.0±0.8) d, and the postoperative hospital stay was (13±6) d. The rate of the postoperative pancreatic fistula was 17.6% (3/17). The spleen infarction occurred in the 2 cases following Warshaw procedure. The pathologic examination showed that there were 2 patients with the serous cystadenoma, 7 patients with the mucinous cystadenoma, 3 patients with the solid pseudo-papillary tumor, 3 patients with the intraductal papillary mucinous cystadenoma neoplasm, and 2 patients with the insulinoma. All patients were followed-up of 5 to 26 months, and the perigastric varice occurred in 1 patient, no recurrence or spleen infarction occurred during following-up. Conclusions LSPDP is a safe, feasible and effective method with less injury and rapid recovery.

关键词: 胰腺肿瘤; 腹腔镜胰体尾切除术; 保留脾脏

Key words: pancreatic neoplasm; laparoscopic distal pancreatectomy; spleen-preservation

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