摘要
目的探讨腹腔镜胰体尾切除的安全性和可行性。方法 2013年1月~2016年6月对30例胰体尾占位性病变施行腹腔镜下胰体尾切除。术中定位肿物及胰腺切线,充分游离胰颈并应用Endo-GIA切断胰腺,根据肿物性质及肿物与脾血管关系决定是否保留脾脏。结果 4例因脾血管出血难以控制中转开腹。行腹腔镜保留脾脏胰体尾切除15例,其中保留脾血管的保脾胰体尾切除(Kimura法)10例,手术时间210~260 min,(232±14)min,术中出血量120~200 ml,(165±21)ml;不保留脾血管的保脾胰体尾切除(Warshaw法)5例,手术时间110~170 min,中位手术时间135 min,术中出血量50~130ml,中位出血量80 ml。胰体尾及脾切除11例,手术时间95~190 min,(137±31)min,术中出血量30~150 ml,(83±41)ml。术后住院时间7~22 d,(12.2±2.4)d。术后病理:黏液性囊腺瘤9例,实性假乳头状瘤7例,神经内分泌肿瘤6例,浆液性囊腺瘤3例,胰腺囊肿3例,导管内乳头状黏液瘤1例,异位脾脏1例。术后胰漏发生率36.7%(11/30),部分脾梗死1例。21例随访中位时间15个月(6~36个月),未见肿瘤复发。结论对于胰体尾良性、交界性或低度恶性肿瘤,选择腹腔镜下胰体尾切除安全可行,创伤小,恢复快。
Objective To investigate the feasibility and safety of laparoscopic distal pancreatectomy(LDP). Methods A total of 30 patients with pancreatic body and tail occupying lesions were treated with LDP during the period from January 2013 to June 2016.The tumor and pancreatic tangent were located in surgery,the pancreatic neck was fully freed,and the Endo-GIA was used to cut off the pancreas.According to the nature of the tumor and the relationship between the tumor and the spleen blood vessels,whether or not to retain the spleen was determined. Results Except for 4 cases converted to open surgery because of bleeding of splenic vessels,the operations were completed successfully in other cases.There were 15 cases of laparoscopic spleen-preserving distal pancreatectomy,including 10 cases of Kimura procedure with the operation time of 210-260 min[mean,(232±14)min]and the amount of blood loss during operation of 120-200 ml[mean,(165±21)ml],and 5 cases of Warshaw procedure with the operation time of 110-170 min(median,135 min)and the amount of blood loss during operation of 50-130 ml(median,80 ml).There were 11 cases of distal pancreatectomy with splenectomy,with the operation time of 95-190 min[mean,(137±31)min]and the amount of blood loss during operation of 30-150 ml[mean,(83±41)ml].The patients were discharged from hospital 7-22 days[mean,(12.2±2.4)days]after surgery.Postoperative pathological examination confirmed 9 cases of mucinous cystadenoma,7 cases of solid pseudopapillary tumor,6 cases of neuroendocrine tumors,3 cases of serous cystadenoma,3 cases of pancreatic cyst,1 case of intraductal papillary mucinous neoplasms,and 1 case of ectopic spleen.The pancreatic fistula occurred in 36.7%(11/30)of patients.There was 1 case of partial splenic infarction.A total of 21 patients were followed up for 6-36 months(median,15 months)and tumor recurrence was not found. Conclusion For borderline tumor,benign tumor and low-grade malignant tumor in the body and tail of the pancreas,LDP is safe and feasible.
作者
柴伟
刘汝海
张执全
李凤山
雷豹
袁俊建
孔德帅
Chai Wei;Liu Ruhai;Zhang Zhiquan(Department of General Surgery,Cangzhou Central Hospital,Cangzhou 061000,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2018年第2期114-117,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜手术
胰腺切除术
胰腺肿瘤
Laparoscopic surgery
Pancreatectomy
Pancreatic neoplasms
