摘要
目的探讨腹腔镜保留脾脏胰体尾切除术(laparoscopic spleen-preserving distal pancreatectomy,LSPDP)的技术要点,分析Kimura法保留脾脏的胰体尾切除术中解剖技巧及手术体会。方法回顾性分析2013年1月至2017年8月皖南医学院第一附属医院肝胆外科采用LSPDP治疗胰体尾部良性肿瘤及部分交界性肿瘤15例患者的病例资料。结果 2例因术中出血难以控制结扎脾血管行脾切除术;2例因术中无法判断肿块部位行中转开腹,术中B超定位;其余11例均行完全腹腔镜下保脾胰体尾切除术。平均肿块最大直径(2.8±1.1)cm,手术时间150～437 min,中位时间[M(P25,P75)] 240(180,270)min,平均术中失血量(313.3±51.3)mL,平均术后住院时间(9.3±2.9)d,平均术后排气时间(2.8±1.9)d,首次进食流质平均时间(3.8±1.9)d。术后4例发生胰漏,其中A级胰漏1例,经保守治疗后好转;B级胰漏3例,经抗感染、抑酶、持续腹腔冲洗后好转,带管出院2例,分别于术后24 d、30 d拔除引流管。15例术后随访9个月至5年,2例术后6个月内复发,分别于6、9个月死亡。3例随访6个月出现胃肠道症状(主要表现为食欲差、进食后呕吐);余10例术后情况良好。结论术前精确的影像学评估、术中精细的解剖联合可靠的腹腔镜止血器械,LSPDP治疗胰腺体尾部良性肿瘤及部分交界性肿瘤是安全、可行的。对LSPDP术中出血进行有效预防,手术才能够安全顺利进行。
Objective To discuss the anatomic skills and experience on laparoscopic spleen-preserving distal pancreatectomy (LSPDP) by Kimura technique. Methods Clinical data of 15 patients with benign and partial borderline tumor of pancreatic body and tail who treated by LSPDP method from Jan. 2013 to Aug. 2017 in the First Affiliated Hospital of Wannan Medical College was analyzed retrospectively. Results Splenic vessels in 2 patients were ligated and the spleen were removed due to intraoperative hemorrhage difficult to control. Two patients received open laparotomy and were located by B-ultrasonic due to the inability to determine the location of the lump in laparoscopy. All the remaining 11 cases received complete LSPDP, the mean lump size was (2.8±1.1) cm, the operation time was 150~457 min, the median operation time [ M ( P 25 , P 75 )] was 240 (180, 270) min, mean blood loss was (313.3±51.3) mL, mean postoperative hospitalization time was (9.3±2.9) days, mean postoperative gastrointestinal function recovery time was (2.8±1.9) d, the time to eat liquid food first was (3.8±1.9) d. Complications were observed in 4 patients, 1 case with A-grade pancreatic fistula was improved after conservative treatment; 3 cases with B-grade pancreatic fistula were improved after anti-infective therapy, inhibition of enzymes and continual negative pressure drainage, 2 cases were discharged with drainage tube, and their drainage tubes was removed respectively on the 24 th day and 30 th day after surgery. Fifteen patients were followed-up for 9 months to 5 years. Among them, recurrence occurred in 2 cases at 6 months after surgery, death occurred at 6 months and 9 months later respectively. Gastrointestinal symptoms occurred in 3 cases at 6 months of follow-up (mainly due to poor appetite and vomiting after eating). In addition, 10 patients were in good conditions, 13 patients didn't recurred. Conclusion Preoperative accurate image evaluation and intraoperative fine anatomy with reliable hemostatic laparoscopic instrument, LSPDP is s
作者
周固超
胡明华
陈琳
韩猛
ZHOU Gu-chao;HU Ming-hua;CHEN Lin;HAN Meng(Department of Hepatobiliary Surgery, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241000, China)
出处
《肝胆胰外科杂志》
CAS
2019年第1期43-46,共4页
Journal of Hepatopancreatobiliary Surgery
关键词
胰腺肿瘤
脾血管
腹腔镜手术
保留脾脏胰体尾切除术
Kimura
法
pancreatic tumor
splenic vessels
laparoscopic surgery
spleen-preserving distal pancreatectomy
Kimura technique
