摘要
目的腹腔镜保留脾脏及脾血管胰体尾切除术(laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation,LSPDP-SVP)逐渐被应用,但目前临床研究仍较少。本研究探讨LSPDP-SVP治疗胰体尾良性或低度恶性肿瘤的安全性、可行性及临床疗效。方法回顾性分析宣城市人民医院(3例)和皖南医学院第一附属医院(18例)2017-02-15-2019-10-22连续收治的21例胰体尾占位性病变患者的临床资料。根据手术方式分为LSPDP-SVP组(12例)和腹腔镜联合脾脏切除的胰体尾切除术(laparoscopic distal pancreatectomy with splenectomy,LDPS)组(9例)。比较分析2组的手术时间、术中出血量、术后肛门排气时间、术后住院时间、并发症及随访资料等指标。结果 2组患者年龄、性别、体质量指数(body mass index,BMI)比较差异均无统计学意义,均P>0.05;LSPDP-SVP组肿瘤大小为(3.68±1.55)cm,小于LDPS组的(5.28±1.67)cm,差异有统计学意义,t=2.711,P=0.014。2组患者均无手术死亡发生,2组患者手术时间、术中出血、术后肛门排气时间、术后住院时间及术后总并发症发生率比较差异均无统计学意义,均P>0.05;2组均无术后腹腔内出血、腹腔感染、肺部感染、切口感染及门静脉血栓发生;LSPDP-SVP组出现B级胰瘘和胃排空延迟各1例,LDPS组发生胃排空延迟1例,均经保守治疗后治愈;LDPS组术后血小板计数比率为(2.12±0.18),高于LSPDP-SVP组的(1.01±0.13),差异有统计学意义,t=3.821,P=0.001。患者随访3~32个月,LSPDP-SVP组未见脾梗塞发生,2组均无胰体尾肿瘤复发以及胃周静脉曲张或破裂出血发生。结论 LSPDP-SVP安全、可行,并发症少、损伤小、术后恢复快,可作为胰体尾良性或低度恶性肿瘤的首选术式。
OBJECTIVE Laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation(LSPDP-SVP)is gradually used by surgeons,however,there are few studies that focus on the surgical technique.The purpose of our study was to investigate the safety,feasibility and clinical effectiveness of LSPDP-SVP for benign or low-grade malignant tumor of the distal pancreas.METHODS To retrospectively analyze the clinical data of 21 patients with space occupying lesions in pancreatic body and tail.These patients were consecutively treated in Department of General Surgery,Xuancheng People’s Hospital and the First Affiliated Hospital of Wannan Medical College from February 15,2017 to October 22,2019.According to the surgical technique,the patients were divided into two groups:LSPDP-SVP group(12 cases)and laparoscopic distal pancreatectomy with splenectomy(LDPS)group(9 cases).The clinical results including operative time,intraoperative blood loss,first flatus time,postoperative hospital stay,postoperative complications and follow-up data were observed and analyzed.RESULTS There was no significant difference in terms of age,sex,body mass index(BMI)between the two groups(P>0.05).The tumor size in LSPDP-SVP group was significantly smaller than that in LDPS group[(3.68±1.55)cmvs(5.28±1.67)cm,t=2.711,P=0.014].There was no mortality in both groups.No differences were seen in operative time,intraoperative blood loss,first flatus time,postoperative hospital stay,and postoperative complications between the two groups(P>0.05).There were no postoperative intra-abdominal hemorrhage,abdominal infection,pulmonary infection,incision infection and portal vein thrombosis in both groups.One patient in LSPDP-SVP group had grade B pancreatic fistula,one patient in LSPDP-SVP group and one case in LDPS group suffered from delayed gastric emptying after operation,all the patients recovered well after conservative treatment.The postoperative platelet count ratio was significantly higher in the LDPS group than that in the LSPDP-SVP group(2.12±0.18 vs 1.01±0.13,t=3.821,P=0.001).There was no spleen infarction in LSPDP-SVP group,and no tumor recurrence,perigastric varices or variceal bleeding occurred in both groups during follow-up which ranged from 3 to 32 months.CONCLUSION LSPDP-SVP is safe and feasible,with less complications,less damage and faster recovery,which should be recommended as the primary choice for the treatment of benign or low-grade malignant tumor in the distal pancreas.
作者
崔巍
王小明
王旭
刘成栋
龚义军
方小三
CUI Wei;WANG Xiao-ming;WANG Xu;LIU Cheng-dong;GONG Yi-jun;FANG Xiao-san(Department of General Surgery,Xuancheng Peoples Hospital,Xuancheng 242000,P.R.China;Department of General Surgery,First Affiliated Hospital of Wannan Medical College,Wuhu 241000,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2020年第12期986-991,共6页
Chinese Journal of Cancer Prevention and Treatment
基金
安徽省重点研究与开发计划(201904a07020021)
宣城市科技计划(201814)。
关键词
腹腔镜
胰体尾切除术
脾脏
脾切除
保留脾血管
laparoscopy
distal pancreatectomy
spleen
Splenectomy
splenic vessel preservation
