摘要
目的探讨腹腔镜保留脾脏胰体尾切除术的可行性及临床价值。方法回顾性分析2015年1月至2017年6月期间17例施行腹腔镜保留脾脏胰体尾切除术患者的临床资料。结果 17例患者均在腹腔镜下完成保留脾脏胰体尾切除术,按Kimura法完成12例,按Warshaw法完成5例。全组患者手术时间为(218±60)min,术中出血量为(136±114)m L,术后开始下床活动时间为(1.4±0.6)d,术后首次进流食时间为(2.0±0.8)d,术后住院时间为(13.4±5.7)d。术后发生生化漏3例,B级胰瘘3例。术后发生脾局灶性梗死2例。术后病理:胰腺浆液性囊腺瘤2例,黏液性囊腺瘤7例,实性假乳头状瘤3例,导管内乳头状黏液性肿瘤3例,胰岛素瘤2例。术后随访5~26个月,平均13个月,无肿瘤复发,未发现脾梗死,发现胃周静脉曲张1例,但未破裂出血。结论腹腔镜保留脾脏胰体尾切除术安全、可行、创伤小及恢复快。
Objective To evaluate feasibility and clinical application value of laparoscopic spleen-preserving distal pancreatectomy（LSPDP）.Method The clinical data of 17 patients underwent LSPDP from January 2015 to June2017 in this hospital were retrospectively analyzed.Results The LSPDP was successfully completed in the 17 cases,with Kimura procedure and Warshaw procedure were performed in the 12 cases and 5 cases,respectively.The operative time was（218±60） min,the intraoperative blood loss was（136±114） m L,the time to get out of bed after surgery was（1.4±0.6） d,the postoperative fasting time was（2.0±0.8） d,and the postoperative hospital stay was（13.4±5.7） d.The rate of the postoperative pancreatic fistula was 17.6%（3/17）.The spleen infarction occurred in the 2 cases following the Warshaw procedure.The pathologic examination showed that there were 2 patients with the serous cystadenoma,7 patients with the mucinous cystadenoma,3 patients with the solid pseudo-papillary tumor,3 patients with the intraductal papillary mucinous cystadenoma neoplasm,and 2 patients with the insulinoma.All the patients were followed-up for 5 to 26 months（average 13 months）,and the perigastric varice occurred in 1 patient,no recurrence or spleen infarction occurred during the following-up.Conclusion LSPDP is a safe,feasible and effective method with less injury and rapid recovery.
作者
李中辉
陈华
陈宏泽
孙备
LI Zhonghui, CHEN Hua, CHEN Hongze, SUN Bei(Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China)
出处
《中国普外基础与临床杂志》
CAS
2018年第8期929-933,共5页
Chinese Journal of Bases and Clinics In General Surgery
基金
国家自然科学基金项目(项目编号:81670583)
关键词
胰腺肿瘤
腹腔镜胰体尾切除术
保留脾脏
pancreatic neoplasm
laparoscopic distal pancreatectomy
spleen-preservation
