腹腔镜胰体尾切除临床应用附23例报告  

Laparoscopic distal pancreatic resection: Report of 23 cases

作　　者：刘荣[1] 赵国栋[1] 胡明根[1] 许大彬[2] 薛瑞华[2] 欧阳才国[2] 

机构地区：[1]解放军总医院肝胆外科,北京100853 [2]北京航天中心医院肝胆外科,北京100049

出　　处：《军医进修学院学报》2011年第2期103-105,108,共4页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的探讨腹腔镜胰体尾切除的适应证、技术要点,评价其可行性及安全性。方法回顾笔者自2003年3月-2010年2月完成的23例腹腔镜胰体尾切除病例,男8例,女15例,年龄(45.2±11.75)岁,术前诊断良性病变21例,恶性疾病2例。结果21例顺利完成手术,2例中转开腹。手术方法包括胰体尾联合脾切除15例,胰体尾(保脾)切除8例。全组手术时间(184.6±122.7)min,出血量(189.8±256.32)ml。3例术后出现胰瘘,其中2例延迟拔除腹腔引流管后自愈,1例超声下穿刺引流置管后治愈。术后平均进食时间(3.79±1.25)d,住院(8.28±2.40)d。病理结果:胰岛素瘤13例(1例多发),无功能胰岛细胞瘤2例,副脾1例,囊腺瘤4例,囊腺癌1例,腺癌2例(中高分化各1例)。平均随访(28.79±19.25)月,1例出现2型糖尿病,1例于术后6个月死亡,1例于术后7月发生脑血栓,其余患者均健在,肿瘤病人无复发。结论腹腔镜胰体尾切除是安全的,适合于胰体尾部良性疾病、交界性肿瘤和早期恶性肿瘤。Objective To study the feasibility,safety,techniques and indications of laparoscopic distal pancreatic resection（LDPS）.Methods Twenty-three patients（8 males,15 females） with a mean age of（45.2±11.75）years who underwent LDPS from March 2003 to February in our department were retrospectively analyzed.Of the 23 patients,21 were diagnosed as benign lesion and 2 as malignant lesion.Results Of the 23 patients,21 were successfully operated and 2 were transferred to laparotomy.Laparoscopic distal pancreatic resection was performed with spleen removed and reserved in 15 and 8 patients,respectively.The operation time was（184.6±122.7）min with a blood loss of（189.8±256.32）ml.Pancreatic fistula occurred in 3 patients,which was cured by delaying drainage time in 2 patients and by ultrasound-guided puncture and drainage in 1 patient.The mean oral food taking time was（3.79±1.25）d and the mean hospital stay time was（8.28±2.40）d after operation.Pathological examination showed insulinoma in 13（multiple insulinomas in 1）,nonfunctional islet cell tumor in 2,cystadenoma in 4,accessory spleen in 1,and adencarcinoma in 2（moderately-differentiated in 1 and well-differentiated in 1） patients,respectively.The mean follow-up time was（28.79±19.25） months during which 1 patient developed type 2 diabetes mellitus,1 patient died 6 months after operation,1 patient developed cerebral thrombosis 7 months after operation.The rest 22 patients were still alive with no recurrence of tumor.Conclusion LDPS is a safe procedure for benign,boundary and early malignancies in distal pancreas.

关 键 词：腹腔镜 胰腺肿瘤 胰腺体尾部切除. 

分 类 号：R657.5[医药卫生—外科学]