保留脾血管的完全腹腔镜胰体尾切除术的临床应用  

Clinical Application of Laparoscopic Splenic Vessel-preserving Distal Pancreatectomy

作　　者：强勇[1] 陈钟[1] 唐伟东[1] 常仁安[1] 朱李瑢[1] 王斐然[1] 

机构地区：[1]南通大学附属医院肝胆外科,江苏南通226001

出　　处：《中国现代手术学杂志》2015年第2期99-102,共4页Chinese Journal of Modern Operative Surgery

基　　金：江苏省"科教兴卫工程"医学领军人才和创新团队项目(LJ201134)

摘　　要：目的探讨保留脾血管的完全腹腔镜胰体尾切除术治疗胰体尾肿瘤的临床价值。方法回顾性分析2013年6月～2014年8月我科行保留脾血管的完全腹腔镜胰体尾切除术3例患者的临床资料,术前上腹部CT及MRI均提示胰腺体尾部占位。其中,单发病灶2例,多发病灶1例;肿瘤直径3～7 cm。结果本组3例均在腹腔镜下成功实施保留脾血管的胰体尾切除术,无中转开腹。手术时间分别为150 min、180 min及240 min,术中出血量分别为120 ml、170 ml及700 ml。脾动脉分支撕裂导致出血1例,行腔镜下缝合修补。术中发现脾下极缺血1例。术后1 d下床活动,2～3 d排气。术后5 d出院2例,1例因发生胰漏延长住院时间,经保守治疗术后21 d带管出院,术后第4周拔除引流管。术后组织病理学检查诊断为胰腺神经内分泌肿瘤伴囊性变1例,实性乳头状瘤1例,神经纤维瘤1例。分别随访1个月、6个月及15个月,均未见肿瘤复发。结论保留脾血管的完全腹腔镜胰体尾切除术是安全可行的,具有创伤小、出血少、恢复快等优点,可作为胰体尾良性或低度恶性肿瘤的首选术式。Objective To explore the clinical value of laparoscopic splenic vessel-preserving distal pancreatectomy（ LA-SVPDP） for tumors in the tail of the pancreas. Methods From June 2013 to August 2014,the clinical data of the 3 patients with the pancreatic tail tumor performed LA-SVPDP in our department were analyzed retrospectively. Among them,there was single lesion in 2 cases and multiple lesions in 1 case. The tumor diameter ranged from 3 to 7 cm. Results All operations were completed successfully under laparoscope without patients converted to open operation. The operation time was 150,180 and 240 minutes,and the intraoperative blood loss was 120,170 and 700 ml,respectively. Intra-operative hemorrhage associated with splenic artery branches torn was found in 1 case and sutured and repaired under laparoscope. Moreover,there was 1 case with splenic lower pole ischemia during the operation. The postoperative hospitalization was 5 days in 2 cases,and was 21 days in 1 case because of post-operative pancreatic leakage. The case was drainaged for 4 weeks and recovered after conservative treatment. The histopathologic result showed pancreatic neuroendocrine tumors combined with cystic degeneration in one case,papilloma in one case and neurofibroma in one case. The three cases were followed up for 1,6 and 15 months respectively. No tumor recurrence was found. Conclusion LA-SVPDP is a feasible and safe procedure with the advantage of mini-trauma,less blood loss,rapid recovery and so on,and it may be the first choice of surgical operation for the benign and low-grade malignant pancreatic neoplasm.

关 键 词：腹腔镜检查 胰体尾切除术 保留脾脏血管 

分 类 号：R657.5[医药卫生—外科学]