脾血管血流控制技术在腹腔镜下Kimura法保脾胰体尾切除术中的应用  

Splenic vascular flow control in the use of laparoscopic spleen-preserving distal pancreatectomy(Kimura)

作　　者：孙旭 曹国良 潘治平 张鸣杰 岑峰 袁文斌 沈振华 郑树森[5] 严强 Sun Xu;Cao Guoliang;Pan Zhiping;Zhang Mingjie;Cen Feng;Yuan Wenbin;Shen Zhenhua;Zheng Shusen;Yan Qiang(Department of Hepato-Pancreato-Biliary Surgery,Huzhou Central Hospital,Zhejiang University School of Medicine,Huzhou 313000,China;Huzhou Peak Discipline of Medicine(General Surgery),Huzhou 313000,China;Huzhou Key Laboratory of Intelligent and Digital Precision Surgery,Huzhou 313000,China;Huzhou Key Disciplinary Group of Medicine(Malignant Tumors),Huzhou 313000,China;Department of Hepato-Pancreato-Biliary Surgery,the First Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]湖州市中心医院浙江大学医学院附属湖州医院普通外科,湖州313000 [2]湖州市医学高峰学科普通外科,湖州313000 [3]湖州市智能数字精准外科重点实验室,湖州313000 [4]湖州市医学重点学科群(恶性肿瘤),湖州313000 [5]浙江大学医学院附属第一医院肝胆胰外科,杭州310000

出　　处：《中华普通外科杂志》2022年第10期755-760,共6页Chinese Journal of General Surgery

基　　金：湖州市科技计划公益性应用研究项目(2019GYB22);湖州市医学重点学科群(恶性肿瘤)(XKQ-HT-202101A);湖州市医学高峰学科(普通外科)(GFXK-HT-202201A)。

摘　　要：目的探讨脾血管血流控制技术在腹腔镜下保留脾脏的胰体尾切除术中的可行性及其应用价值和技术要点。方法回顾性分析2014年5月至2021年10月湖州市中心医院收治的因胰腺良性或低度恶性疾病拟行腹腔镜下保脾胰体尾切除术(laparoscopic spleen-preserving distal pancreatectomy,LSPDP)的45例患者的临床资料,根据术中脾血管血流控制技术将患者分为血流控制组(n=22)和常规组(n=23)。结果两组患者在性别、年龄、BMI、伴随症状、高血压、糖尿病、病灶大小、病理诊断等方面差异均无统计学意义(均P>0.05)。血流控制组整体保脾率高于常规组(90.9%比52.2%,χ^(2)=8.213,P=0.004),Clavien分级≥Ⅱ级并发症发生率显著低于常规组(22.7%比73.9%,χ^(2)=9.911,P=0.002),术后平均住院日低于常规组[(9.6±4.5)d比(14.3±6.6)d,t=2.447,P=0.008]。结论脾血管血流控制技术提高了腹腔镜下胰体尾切除术中保脾的成功率,减少了术后并发症,缩短了术后住院时间。Objective To investigate the techniques used in blood flow control of Kimura laparoscopic spleen-preserving pancreatectomy(LSPDP).Methods Forty·five patients with benign or low-grade malignant pancreatic diseases undergoing LSPDP at Huzhou Central Hospital from May 2014 to Oct 2021 were analyzed retrospectively.Patients were divided into splenic vascular flow control group(n=22)and routine management group(n=23).Results There was no significant difference in gender,age,BMI,accompanying symptoms,hypertension,diabetes,lesion size and pathological diagnosis between the two groups(all P>0.05).A higher overall spleen preservation rate(90.9%vs.52.2%,χ^(2)=8.213,P=0.004),lower incidence of morbidity with Clavien grade≥Ⅱ(22.7%vs.73.9%,χ^(2)=9.911,P=0.002)and shorter postoperative hospital stay[(9.6±4.5)d vs.(14.3±6.6)d,t=2.447,P=0.008]were achieved in the vascular flow control group compared with those in the routine group.Conclusion Splenic vascular flow control techniques improve the success rate of spleen preservation in laparoscopic distal pancreatectomy,reduce the postoperative complications and shorten the postoperative hospital stay.

关 键 词：胰腺切除术 腹腔镜 保留脾脏 血流控制 

分 类 号：R657.5[医药卫生—外科学]