完全腹腔镜下保留脾脏胰体尾切除术18例分析  

Total laparoscopic spleen-preserving distal pancreatectomy： report of 18 cases

作　　者：姚捷[1] 钱建军[1] 柏斗胜[1] 李振南[1] 丁向民[1] 蒋国庆[1] 赵龙[1] 王小东[1] 金圣杰[1] 苗毅[2] 

机构地区：[1]江苏省苏北人民医院胆胰外科,江苏扬州225001 [2]江苏省人民医院普外科

出　　处：《中华胰腺病杂志》2015年第1期6-9,共4页Chinese Journal of Pancreatology

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。方法回顾性分析江苏省苏北人民医院胆胰外科2008年2月至2014年2月间行腹腔镜下保留脾脏胰体尾切除术的18例患者的临床资料。结果18例患者中男性5例，女性13例，年龄16～75岁。术前诊断均为胰体尾良性肿瘤。手术采用肠系膜前方隧道人路（Kimura法）10例，脾静脉前方入路4例，脾静脉后方入路（Warshaw法）4例。平均手术时间（235±45）min。平均术中出血（447±299）ml。术后4～7d开始进食。术后平均住院（11．8±6．1）d。术后无再次手术，无腹腔内出血、消化道出血、胃瘫等并发症，无围手术期死亡。术后并发胰瘘5例，均为A级，经非手术治疗后治愈。病理诊断为囊腺瘤10例，其中2例伴有轻．中度异形增生；实性假乳头状瘤4例；神经内分泌肿瘤3例；无功能胰岛细胞瘤1例。术后随访时间1个月～4年。无2型糖尿病发生，无肿瘤复发。结论对于胰腺体尾部良性肿瘤，腹腔镜下保留脾脏的胰体尾切除术是安全可行的，具有损伤小、恢复快等优势，值得推广应用。Objective To describe the indications, and key techniques of laparoscopic spleen- preserving distal pancreatectomy （ LSPDP ）, to evaluate the feasibility and safety of LSPDP. Methods Clinical data of 18 patients underwent LSPDP from February 2008 to February 2014 in Northern Jiangsu People＇s Hospital were retrospectively analyzed. Results Among the 18 patients, 5 were male and 13 were female, with the age ranging from 16 - 75 years old. They had a preoperative diagnosis of pancreatic benign tumor located in body and tail of the pancreas. Kimura procedure was used in 10 cases, splenic vein anterior approach in 4 and Warshaw procedure in 4 cases. The average duration of the surgery was （ 235 ± 45 ） minutes, and the average blood loss was （ 447 ± 299 ） ml. Food intake was resumed 4 - 7 d after the procedure. The average postoperative hospital stay was （ 11.8 ± 6.1 ） d. There was no second surgery, no intra- abdominal hemorrhage, gastrointestinal bleeding, or delayed gastric emptying, and there was no perioperative mortality. Five cases developed grade A pancreatic fistula, and all were cured after non-surgical management. The pathological diagnosis was as follows： cystadenoma in 10 cases, including two cases with mild-moderate dysplasia; solid pseudopaillary neoplasm in 4 cases; neuroendocrine tumors in 3 cases; nonfunctioning islet cell tumor in 1 case. The patients were followed from 1 month to 4 years, and no type II diabetes occurred and no tumor reoccurred. Conclusions For benign tumor in the body and tail of the pancreas, laparoscopicspleen-preserving distal pancreatectomy is feasible and safe, with less damage and faster recovery, and it is worth of wide application.

关 键 词：腹腔镜检查 胰腺切除术 保留脾脏 疗效 

分 类 号：R657.5[医药卫生—外科学]