摘要
目的探讨腹腔镜下保留脾脏胰体尾切除中保留脾动静脉的可行性及技术要点。方法回顾性分析2008年2月至2015年2月完全腹腔镜下保留脾脏胰体尾切除术19例患者临床资料,术前诊断均为胰体尾良性病变。结果完全腹腔镜下保留脾动静脉的胰体尾切除术18例,1例保留脾静脉时出血多,被迫行腹腔镜下联合脾脏切除的胰体尾切除。手术时间180-330 min,平均（228.35±41.90）min。术中出血200-1 200 ml,平均（298±308.51）ml。术后进食时间4-7 d。术后住院日7-14 d,平均（8.829±2.17）d。术后无二次手术,无围手术期死亡。术后无腹腔内出血、消化道出血、胃瘫等并发症。并发胰瘘4例（22.2%）,均为A级瘘,保守治疗后治愈。术后病理诊断：囊腺瘤13例,其中2例伴有轻-中度异形增生;实性假乳头状瘤4例;神经内分泌肿瘤2例。术后12例获得随访,随访时间1个月-4年。无2型糖尿病发生。无肿瘤复发。结论对于胰腺体尾部良性肿瘤,腹腔镜下保留脾动静脉的保留脾脏胰体尾切除术安全可行的,损伤小、恢复快,值得推广应用。
Objective To investigate the indications and key techniques in vessel preserving laparoscopic spleen-preserving distal pancreatectomy（ LSPDP） and to evaluate the feasibility and safety of LSPDP. Methods The clinical data of 19 patients with preoperative diagnosis of pancreatic benign tumor located in the body and tail of the pancreas underwent LSPDP in our hospital from Feb 2008 to Feb 2015 were retrospectively analyzed. In these patients 5 were males and 14 females,aged from 16 to 75 years.Results Eighteen patients underwent laparoscopicsplenic vessel preserving splenic-preserving distal pancreatectomy,and one patient was converted to laparoscopic distal pancreatectomy with splenectomy. The average duration of surgery was（ 228. 35 ± 41. 90） minutes（ range 180- 330 minutes）. Average blood loss was（ 298 ± 308. 51） ml（ range 200- 1 200 ml）. Average postoperative eating time was 4- 7 days.Average postoperative hospital stay was（ 8. 829 ± 2. 17） days（ range 7- 14 days）. There was neither secondary surgery nor perioperative mortality. No intra-abdominal hemorrhage,gastrointestinal bleeding,delayed gastric emptying and other complications occurred. Four patients（ 22. 2%） developed pancreatic fistulae in grade A,which were cured conservatively. Twelve patients were followed up for 1 month to 4years. There were no patients with type 2 diabetes and tumor recurrence after surgery. Conclusion For benign tumor in the body and tail of the pancreas,laparoscopic splenic vessel preserving splenic-perserving distal pancreatetomy is safe and feasible,and it is characterized by less injury and faster recovery.
出处
《中华普外科手术学杂志（电子版）》
2015年第6期82-84,共3页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
