左肾旁前间隙入路在保留脾脏的腹腔镜胰体尾切除术的应用  

The left anterior pararenal space approach in laparoscopic distal pancreatectomy with splenic preservation

作　　者：吴伟顶[1] 胡智明[1] 张成武[1] 张宇华[1] 尚敏杰[1] 陆一定 赵大建[1] 

机构地区：[1]浙江省人民医院肝胆胰外科、微创外科,杭州310014 [2]浙江省人民医院海宁医院普外科

出　　处：《中华肝胆外科杂志》2014年第1期35-38,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨对胰体尾部良性肿瘤患者进行保留脾脏切除胰体尾的手术入路与安全性.方法回顾性分析2008年8月至2013年9月我院30例保留脾脏胰体尾切除术的临床资料.结果保留脾动、静脉的保脾胰体尾切除术28例,离断脾血管、保留胃短血管的保脾胰体尾切除术2例.30例患者手术均顺利完成,平均手术时间（55＆#177;38）min,术中出血量（100＆#177;48）ml,术后平均住院时间7.8d.术后病理诊断为胰岛细胞瘤5例、胰腺囊肿4例、慢性胰腺炎性肿块3例、胰腺实性假乳头状瘤6例、黏液性囊腺瘤6例、浆液性囊腺瘤6例.术后1例患者部分脾梗死,2例发生胰漏,延迟拔管后治愈出院.结论左肾前间隙入路是腹腔镜保留脾脏的胰体尾切除术安全、快捷的手术入路.对于胰体尾占位病变较大以及病变紧贴并压迫脾动、静脉的患者可考虑离断脾血管而保留胃短血管的保脾胰体尾切除术.该手术入路安全,具有恢复快、并发症少等优点,值得推广.Objective To explore the safety of the left anterior pararenal space approach in laparoscopic distal pancreatectomy with splenic preservation.Methods 30 patients operated between August 2008 and September 2013 were retrospectively reviewed.Results Of the 30 patients,28 underwent laparoscopic distal pancreatectomy with preservation of splenic artery and vein,2 underwent laparoscopic distal pancreatectomy with division of the splenic artery and vein and preservation of the short gastric vessels.All the 30 patients had their operations carried out successfully with an average operative time of （55 ＆#177; 38） min,blood loss （100 ＆#177; 48） ml and duration of hospitalization 7.8 d.Pancreatic fistula occurred in 2 patients and it healed spontaneously on drainage.Partial splenic infarction occurred in 1 patient.The pathological lesions were serous cystadenoma in 6 patients,mucinous cystadenoma in 6 patients,insulinoma in 5 patients,solid pseudopapillary tumor in 6 patients,chronic pancreatitis presenting as a mass in 3 patients,and pancreatic cyst in 4 patients.Conclusions The left anterior pararenal space approach was safe and efficacious in distal pancreatectomy with splenic preservation.If the pancreatic lesion was big and compressed the splenic artery and vein,laparoscopic distal pancreatectomy with division of the splenic artery and vein and preservation of the short gastric vessels was the procedure of choice.

关 键 词：胰腺肿瘤 胰腺切除术 保脾 手术入路 

分 类 号：R657.5[医药卫生—外科学]