腹腔镜下保留脾脏的胰体尾切除术的临床研究

目的:探讨腹腔镜下保留脾脏的胰体尾切除术的临床价值。方法:回顾分析2014年11月至2016年4月为3例胰腺体尾部肿瘤患者行腹腔镜下保留脾脏的胰体尾切除术的临床资料。结果:3例均成功施行腹腔镜下保留脾血管的保脾手术,无中转开腹,其中1例术中撕裂脾静脉,腹腔镜下缝合脾静脉撕裂处,成功止血,72 h后恢复进食。1例患者因囊性肿瘤巨大,术中囊液外溢,造成术后胰腺切除区形成直径3 cm包裹性积液,术后2周自行吸收。术后病理均回报为胰腺粘液性囊腺瘤。出院后随访3～12个月,未见远期并发症及复发病例。结论:腹腔镜下保留脾脏的胰体尾切除术目前已成为治疗胰体尾良性肿瘤安全、可行的新选择,因其创伤小、康复快,已成为治疗胰体尾良性肿瘤的常规手术,目前也可在基层医院开展,但此术式仍需严格遵守循序渐进的推行原则。

Clinical study of laparoscopic spleen-preserving distal pancreatectomy

Objective:To investigate the clinical value of laparoscopic spleen-preserving distal pancreatectomy. Methods:A retrospective analysis was made on the clinical data of 3 patients who suffered from tumor in body and tail of pancreas and underwent laparoscopic spleen-preserving distal pancreatectomy from Nov. 2014 to Apr. 2016. Results:All 3 cases were successfully performed laparoscopic spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein,and no case was converted to lapa-rotomy. The splenic vein was torn in 1 case,laparoscopic suturing was used for the splenic vein sutures,and bleeding was successfully stopped. The patient ate liquid food at 72 h after operation. 1 patient suffered from large cystic tumor,the cystic fluid overflowed during the operation,postoperative encapsulated effusion with diameter of 3 cm formed at pancreatic resection area. The encapsulated effusion was absorbed in 2 weeks after operation. Postoperative pathological examination all revealed the diagnosis of pancreatic mucinous cystad-enoma. No long-term complications or recurrence were found during the follow-up of 3 to 12 months. Conclusions:Laparoscopic spleen-preserving distal pancreatectomy has become a safe and feasible choice of the treatment of benign tumor at body and tail of the pancre-as,because of its mini-trauma,rapid recovery,in many large medical centers laparoscopic spleen-preserving distal pancreatectomy has become the general treatment of benign tumor at pancreatic body and tail. At present,laparoscopic spleen-preserving distal pancreatecto-my can be carried out in primary hospital. However,surgeons who perform this operation should strictly abide by the principle of gradual implementation.