腹腔镜保留脾脏胰体尾切除术  

Assessment of laparoscopic spleen-preserving distal pancreatectomy

作　　者：戴梦华[1] 石宁[1] 刘尚龙[1] 廖泉[1] 张太平[1] 郭俊超[1] 丛林[1] 陈革[1] 胡亚[1] 刘子文[1] 赵玉沛[1] 

机构地区：[1]中国医学科学院北京协和医院基本外科,北京100730

出　　处：《中华普外科手术学杂志（电子版）》2013年第3期22-24,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家自然科学基金项目(81071898)

摘　　要：随着腹腔镜技术的成熟,腹腔镜胰腺手术也得到进一步开展,其中腹腔镜胰腺远端切除手术是目前开展例数最多,最具有腹腔镜技术优势的手术。目前腹腔镜胰腺远端切除手术主要适应证为位于胰体尾的良性或者低度恶性肿瘤。随着脾脏功能认识的不断深入,保留脾脏功能的手术越来越受到重视。腹腔镜下保留脾脏功能的方法主要有保留脾脏血管和不保留脾脏血管的术式,即Kimura法和Warshaw方法。Kimura方法技术要点是在离断胰腺后,将远端胰腺提起,由右向左分离远端胰腺和脾脏血管至脾门,分离钳夹分支血管,切除远端胰腺及肿物。Warshaw方法是在离断胰腺后,同时离断脾脏血管,连同脾脏血管一起游离远端胰腺至脾门处,分离出脾门血管后离断,保留胃短血管及胃网膜左血管,以保证脾脏血液供应。本文对两种方法的技术环节及优缺点进行论述,以其最大程度保留脾脏功能。With the development of minimal invasive surgery, laparoscopic pancreatectomy has been greatly improved, including laparoscopic duodenopancreatectomy, laparoscpic distal pancreatectomy, and enucleation of tumor. Laparoscopic distal pancreatectomy is the most widely accepted procedure because it is easier to perform without pancreatic anastomosis. The indications for distal pancreateetomy are presumably benign lesions and low grade malignant tumors. Splenic preservation is the general aim to keep the function of the spleen and avoid infectious complications after splenectomy. Two alternative techniques are discussed to keep the function of the spleen, sparing of the splenic vessels （ Kimura procedure） or splenic preservation with sacrifice of the splenic artery and vein （Warshaw procedure） The operative procedures are mostly identical in the two techniques. When splenic vascular injury occurs during pancreatectomy （usually involving the splenic vein）, it may be necessary to perform the Warshaw procedure so as to preserve the spleen. In this paper, we described the techniques of laparoscopic spleen-preserving distal pancreatectomy with or without preservation of the splenic artery and vein.

关 键 词：胰腺肿瘤 腹腔镜检查 胰腺切除术 保留脾脏 

分 类 号：R735.9[医药卫生—肿瘤]