摘要
目的探讨腹腔镜保留脾脏和脾血管的胰体尾切除术治疗胰体尾囊性肿瘤的可行性。方法回顾性分析2013年3月中山大学孙逸仙纪念医院收治的1例胰体尾囊性肿瘤患者的临床资料。术前结合患者一般情况及CT影像资料，制订保留脾脏和脾血管的腹腔镜胰体尾切除术为首选治疗方案，如术中脾血管难以与胰体尾充分游离或出现难以控制的出血，必要时转为腹腔镜或开腹联合胰体尾＋脾脏切除术。术后每1～3个月门诊随访，随访时间截至2015年3月。结果患者顺利完成保留脾脏和脾血管的腹腔镜胰体尾切除术。患者手术时间为192min，术中出血量约50mL。患者术后第1天即可下床活动，无术后并发症发生。术后病理学检查结果：胰腺多发微囊型浆液性囊腺瘤，最大直径为3．5cm。术后第5天拔除引流管。术后第1、3、5天检测患者血清淀粉酶均正常。患者术后无出血、胰液漏、感染等并发症发生，患者于术后第8天出院。术后定期随访，腹上区隐痛不适症状无再发作。结论保留脾脏和脾血管的腹腔镜胰体尾切除术治疗胰体尾囊性肿瘤具有创伤小、术后恢复快、保留了脾脏功能完整性等优势，值得推广应用。
Objective To investigate the feasibility of spleen- and splenic vessels-preserving laparoscopic distal pancreatectomy for the treatment of pancreatic cystic tumor of body and tail. Methods The clinical data of a female patient with pancreatic cystic tumor of body and tail who was admitted to the Sun Yat-Sen Memorial Hospital of the Sun Yat-Sen University in March 2013 were retrospectively analyzed. Spleen- and splenic vessels- preserving laparoscopic distal pancreatectomy was determined as the optimal therapeutic method according to the physical examination and the results of computered tomography scan. Laparoscopic or open operation combined with distal pancreatectomy and splenectomy would be carried out as a candidate choice once it is hard to separate the splenic artery and vein from distal pancreas or to control the serious vessels hemorrhage. The patient was followed up by outpatient examination every 1 to 3 months up to March 2015. Results Spleen- and splenic vessels-preserving laparoseopie distal pancreatectomy was finished successfully. The operation time and volume of intraoperative blood loss were 192 minutes and 50 mL, respectively. The patient took out-of-bed for activity at postoperative day 1 without complications. The multiple severe microcystic pancreatic adenoma was confirmed by postoperative pathological examination, with a maximum diameter of 3.5cm. The leakage tube was removed at postoperative day 5. The levels of serum amylase at postoperative day 1, 3, 5 were normal. The patient was discharged at postoperative day 8 and got regular follow-up without bleeding, pancreatic fistula, infection and a symptom of epigastric pain or discomfort. Conclusion Spleen- and splenic vessels-preserving laparoscopic distal pancreatectomy has advantages of less traumas, faster postoperative recovery and a preservation of normal splenic function, deserving clinical application.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2015年第8期673-676,共4页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金（81372562）
广东省科技计划项目（20128031800378）
高校基本科研业务费中山大学青年教师培育项目（14ykpy21）
