Kimura法与Warshaw法在腹腔镜保留脾脏的胰体尾切除术中的临床对照研究

摘 要] 目的 探讨Kimura法与Warshaw法两种腹腔镜保留脾脏的胰体尾切除术方法的安全性。方法回顾性分析咸阳市第一人民医院2014年9月至2017年9月共13例行腹腔镜保留脾脏的胰腺体尾良性病变切除术患者资料，其中Kimura组8例，Warshaw组5例，对两种手术方式术中出血量、手术时间、术后排气时间及术后住院时间等方面进行对比研究。结果 两组均手术成功，无中转开腹，无中转腹腔镜胰体尾切除+脾脏切除术病例。两组术中出血量（62.5±45.7）mL vs （84.3±52.2）mL]，手术时间（274.4±32.1）min vs （283.2±24.8）min]，术后排气时间（1.3±0.5）d vs （1.8±0.9）d]，以及术后住院时间（9.3±4.5）d vs （10.7±6.9）d]差异均无统计学意义（P＞0.05）。Warshaw组1例术后CT提示无症状的部分脾梗死发生，1例发生胃静脉曲张。两组患者无其他近远期并发症及再次手术发生，无病变复发，无胃静脉曲张破裂出血发生。结论两种手术方式均是安全和有效的，与Kimura法相比，Warshaw法无症状脾梗死、胃底静脉曲张发生率较高。但在肿瘤或胰腺病变与脾血管分离困难时，选择Warshaw法更为合适。

A clinical controlled study of laparoscopic spleen-preserving distal pancreatectomy with the Kimura technique versus the Warshaw technique

AbstractobjectiveTo investigate the safety of laparoscopic spleen-preserving distal pancreatectomy with the Kimura technique versus the Warshaw technique.MethodsThirteen patients with benign lesion in the distal pancreas underwent laparoscopic spleen preserving distal pancreatectomy from Sep. 2014 to Sep. 2017 were collected retrospectively. Eight patients underwent Kimura technique (Kimura group) and 5 patients underwent Warshaw technique (Warshaw group). The intraoperative blood loss, operative time, postoperative exhaust time, and postoperative hospitalization duration were compared between two groups.ResultsThere was no case conversion to laparotomy, and there was no case switched to laparoscopic spleen sacrificed distal pancreatectomy in either group. There was no statistical difference between the two groups in the intraoperative blood loss (62.5±45.7) mL vs (84.3±52.2)] mL, operative time (274.4±32.1) min vs (283.2±24.8) min], postoperative exhaust time (1.3±0.5) d vs (1.8±0.9) d], length of the postoperative hospitalization (9.3±4.5) d vs (10.7±6.9) d] (P>0.05). In the Warshaw group, 1 case of partial spleen infarction without symptoms was observed by CT and 1 case of gastric varicosity was found. There was no rupture of varices, recurrence, or reoperation case, and there was no other recent or late complication in either group.ConclusionThe two techniques are safe and effective. Compared with the Kimura technique, the incidence of asymptomatic splenic infarction and gastric varices is higher in Warshaw technique. However, the choice of Warshaw technique is more appropriate when the tumor and pancreatic lesions are difficult to separate from the splenic vessels.