腹腔镜保留脾脏胰体尾切除术治疗胰腺囊性疾病6例报告

目的总结腹腔镜保留脾脏胰体尾切除术的临床经验与手术技巧。方法自2003年11月至2006年7月，我们对6例胰腺囊性疾病患者施行保留脾血管的腹腔镜保留脾脏胰体尾切除术。结果本组6例均在腹腔镜下完成，其中1例合并右肾上腺肿瘤切除，1例合并子宫肌瘤切除、左卵巢畸胎瘤切除，1例合并子宫肌瘤切除，1例合并胆囊切除。手术时间140～265min，出血350～600ml。术后住院时间4—9d，无胰漏发生。随访1—31个月，症状消失，未见复发。病理诊断：潴留性囊肿2例，浆液性囊腺瘤2例，黏液性囊腺瘤2例。结论对于胰体尾部良性病变，应首选保留脾血管的腹腔镜保留脾脏胰体尾切除术，施行保留脾血管的腹腔镜保留脾脏胰体尾切除术是安全可行的。     

经腹腔镜胰体尾部切除术治疗胰腺良性肿瘤

目的 探讨腹腔镜胰体尾部切除治疗胰腺良性肿瘤的方法 及安全性、可行性.方法 2009年11月到2010年5月,对3例胰腺体尾部占位性病变的病人实施了腹腔镜胰体尾部切除术(1例保留脾脏,2例联合脾脏切除).结果 所有手术均在手辅助腹腔镜下成功完成.手术时间75～185 min,平均120 min;出血量90～210 ml...     

腹腔镜胰腺远端切除术26例

目的探讨腹腔镜胰腺远端切除术的安全性、可行性。方法2005年9月～2008年6月,对26例胰腺体尾部肿物行腹腔镜胰腺远端切除术。术前25例诊断为胰腺体尾部良性肿物,1例不除外恶性,肿物中位直径5cm（1.2～10cm）。结果所有手术均在全腹腔镜下完成。15例行保留脾脏的胰体尾切除（10例保留脾动静脉,5例未保留脾动静脉）,10例行胰体尾加脾切除,1例既往行胰体尾及脾切除者行胰体部切除。手术中位时间268.5min（129～400min）,中位出血量100ml（50～800ml）,术后中位住院时间9d（6～21d）。无胰漏或脾梗死发生,2例包裹性积液,均保守治疗治愈,1例引流管口感染。26例中位随访时间15.5月（1～35个月）,均无复发。结论胰腺体尾部良性肿物行腹腔镜胰腺远端切除术安全、可行。     

腹腔镜下保留脾脏的胰体尾切除术23例

目的探讨完全腹腔镜下保留脾脏的胰体尾切除术在治疗胰腺体尾部占位的安全性、可行性及操作技巧。方法2008年6月至2013年4月,我院对23例胰体尾良性肿瘤病人施行腹腔镜下保留脾脏的胰体尾切除术,男性7例,女性16例,平均年龄42.4岁。按Kimura法完成13例,按Warshaw法完成10例。结果全部23例无一例中转开腹。平均手术时间253 min;平均出血量245 ml;术后平均住院日7.3天;平均随访期46.3月。无一例复发。结论对胰体尾部的良性肿瘤行腹腔镜下保留脾脏的胰体尾切除术是安全可行的。     

腹腔镜胰腺远端切除术临床应用

目的探讨腹腔镜胰腺远端切除术的安全性及可行性。方法 2005年9月至2009年6月,对36例胰腺体尾部肿物行腹腔镜胰腺远端切除术。术前34例诊断为胰腺体尾部良性肿物,2例不除外恶性,肿物中位直径5cm,平均(1.2～12)cm。结果所有手术均在全腹腔镜下完成。21例行保留脾脏的胰体尾切除(15例保留脾动静脉,6例未保留脾动静脉),14例行胰体尾加脾切除,1例既往行胰体尾及脾切除者行胰体部切除。手术中位时间248min,平均(118～400)min,中位出血量100ml,平均(50～800)ml,术后中位住院时间9d,平均(6～21)d。无胰漏或脾梗死发生,2例包裹性积液,均保守治疗治愈,1例引流管口感染。所有患者得到随访,中位随访时间25.5个月,平均(1～46)个月,均无复发。结论胰腺体尾部肿物行腹腔镜胰腺远端切除术安全、可行。     

胰腺体尾部肿瘤的术式选择

目的探讨不同类型胰腺体尾部肿瘤手术方式的选择。方法回顾性分析我院2003年1月至2008年12月收治的25例胰腺体尾部肿瘤的临床资料。结果 25例中男16例,女9例。上腹饱胀不适及腰背部疼痛为最主要的症状。25例患者均行手术治疗,其中行胰体尾+脾+胃部分切除1例,胰体尾切除+脾切除9例,保留脾脏的胰体尾切除3例,胰腺节段切除3例,肿物局部切除1例,其余行肿瘤活检术。结论对胰腺体尾部肿瘤,应采取个体化的手术方式。恶性肿瘤强调根治性,良性肿瘤则应强调保护周围脏器和胰腺功能。     

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。     

保留脾脏和脾脏血管的胰体尾切除术

目的 探讨胰腺体尾部病变行保留脾脏和脾脏血管的胰体尾切除术的可行性与适应证.方法 对我院200r7年3月至6月间收治的3例胰腺体尾部病变患者.施行保留脾脏与脾脏血管的胰腺体尾部切除术.术中仔细解剖胰腺体尾部,显露牌动静脉,不离断脾动静脉和胃短血管,不游离脾脏.术后在胰腺断面常规放置引流管.结果 3例患者均成功完成保留脾脏和脾脏血管的胰体尾切除术,术中均未输血.术后并发胰瘘1例、并发创伤性胰腺炎1例,均经非手术治疗痊愈.结论 保留脾脏和脾脏血管的胰腺体尾部切除术是安全可行的,对于胰腺体尾部良性病变、尤其是儿童患者,本手术应作为首选的术式.     

保留脾脏的胰体尾部良性肿瘤切除

目的探讨保留脾脏胰体尾切除的可行性和安全性以及并发症预防。方法回顾性分析总结2009年1月至2011年12月行保留脾脏胰体尾切除术5例资料,其中保留脾脏血管的开腹保脾胰体尾切除3例,切断(或切除)脾脏血管的保脾胰体尾切除术1例,腔镜下保脾胰体尾部切除术1例。结果本组无手术死亡,术后均未发生胰瘘、脾梗死、脾脓肿及脾出血等。随访3～6月,无并发症发生。结论胰体尾部良性肿瘤,应首选保留脾脏的胰体尾切除方法,手术安全,效果好,且避免了脾脏的不必要切除。     

多发胰岛细胞瘤行保脾腹腔镜胰体尾切除术1例报告

<正>胰体尾+脾切除术一直是治疗胰体尾病变的经典术式,由于脾脏与胰腺关系紧密,操作时易受损伤。因此,保留脾脏的胰体尾切除术难度较大[1]。保留脾脏的腹腔镜胰体尾部多发肿瘤切除国内罕见,尚未见报道。吉林大学第一医院肝胆外科为1例胰体尾多发胰岛细胞瘤患者成功地施行了保留脾脏的腹腔镜胰体尾切除术。患者男,35岁,因患有阵发性意识障碍1年入院。患者每次发作均以"低血糖"治疗。1周前来我院内分泌科就诊,诊断为胰岛细胞瘤,遂转入手术治疗。查体:腹部无     

保留脾脏的胰体尾肿瘤切除术的应用探讨

目的探讨保留脾脏的胰体尾肿瘤切除术在胰体尾部肿瘤治疗中的可行性及作用。方法收集大连市中心医院于1999年1月至2010年12月期间收治的胰体尾肿瘤患者49例,其中行保留脾脏的胰体尾肿瘤切除术18例,包括胰腺腺癌7例,胰尾囊腺瘤9例,胰岛素瘤2例,其中3例患者接受了腹腔镜辅助保留脾脏胰体尾肿瘤切除术。回顾性分析患者的临床症状、术前检查、术后并发症等指标,并进行术后随访观察。结果开腹和腹腔镜辅助保留脾脏胰体尾肿瘤切除术均顺利实施．所选术式患者耐受性好,术后并发症少,多数患者获得长期生存。结论术前影像学检查和肿瘤标志物检查是早期诊断胰体尾肿瘤的可靠办法,CTA、DSA等检查是术前判定的重要手段,保留脾脏的胰体尾肿瘤切除术应作为胰体尾肿瘤的首选术式。腹腔镜辅助保留脾脏胰体尾肿瘤切除术是安全可行的,具有创伤轻、恢复快、并发症少等优点。     

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??Vascular disposal in laparoscopic spleen-preserving distal pancreatectomy??An analysis of 22 patients HUANG He-guang, CHEN Yan-chang, LU Feng-chun, et al. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
Corresponding author: HUANG He-guang, E-mail: hhuang2@aliyun.com
Abstract Objective To investigate experience with the techniques of vascular disposal in laparoscopic spleen-preserving distal pancreatectomy. Methods The clinical data of 22 patients with benign or borderline pancreas pancreatic tumors performed a spleen-preserving distal pancreatectomy from February 2010 to December 2013 in Fujian Medical University Union Hospital were analyzed retrospectively. Results Among 22 patients, splenic artery and vein were conserved in 16 patients, while neither in 2 patients. Splenic artery was ligated with conservation of splenic vein in 2 patients. And splenic vein was ligated with conservation of splenic artery in 2 patients. All distal pancreatectomies with spleen preservation were completed laparoscopically. And all patients remained a good blood supply to spleen at a follow-up of 3 months to 4 years. Conclusion Depending on the relationship between tumors and vessels, the spleen can be safely preserved laparoscopically using different vascular disposal methods in benign or borderline pancreatic tumors.     

保留脾脏腹腔镜胰尾肿瘤切除术5例报告

目的探讨腹腔镜保留脾、胰尾肿瘤切除术的可行性。方法2001年11月至2006年2月间，暨南大学第二临床医学院（深圳市人民医院）肝胆外科对5例胰尾肿瘤的病人实施保留脾脏腹腔镜胰尾肿瘤切除术。结果手术过程顺利，肿瘤完整切除，其中2例为手助腹腔镜、3例在全腹腔镜下完成，术中出血50—150mL，手术时间90～180min，术后第2天进食、下床活动，1例少量胰瘘，1例胰腺假性囊肿形成。5例病人均痊愈出院。结论腹腔镜对于胰尾的孤立肿瘤切除是微创、安全、可行的，值得进一步推广。     

Laparoscopic spleen-preserving distal pancreatectomy

Distal pancreatectomy with spleen preservation may be the preferred procedure for certain benign tumors and cystic lesions of the pancreatic body or tail. Alternatively, laparoscopic removal including either distal pancreatectomy with splenectomy or splenic-preservation with ligation of the splenic vessels have also been described. We describe, herein, our method to perform spleen-preserving laparoscopic distal pancreatectomy that preserves the splenic vessels and hence splenic function. The described technique of spleen-preserving distal pancreatectomy has been used in two patients with favorable results. Both patients underwent laparoscopic distal pancreatectomy with splenic conservation for an oligocystic serous cystadenoma and serous cystadenoma. Operative time was 3–6 hours with total blood loss of less than 200 cc in both cases. The length of stay in the hospital was 4–8 days and both patients returned to work within 3 weeks. Laparoscopic spleen-preserving distal pancreatectomy should be considered for younger patientswith select body or tail lesions that are not candidates for less extensive procedures.     

Laparoscopic pancreatectomy: report of 22 cases

OBJECTIVE: To evaluate results of laparoscopic pancreatectomy for benign lesions of the pancreas. Peri-operative data, surgical outcomes and techniques are presented. PATIENTS AND METHODS: Eighteen women and four men underwent laparoscopic pancreatectomy and were collected retrospectively from 1999 to 2003. RESULTS: Laparoscopic pancreatectomy was attempted in 22 patients and completed successfully in 18: 10 enucleations, three distal pancreatectomies, four left pancreatectomies and one total pancreatectomy for endocrine and cystic tumors. Left and distal pancreatectomies were performed with preservation of the spleen. Four patients were converted (one enucleation, one whipple procedure and two left pancreatectomy). There was no mortality; the post-operative morbidity included two pancreatic leaks and one case of half splenic infarction. The median length of hospital stay was 12 days. CONCLUSION: Patients appear to benefit from laparoscopic pancreatectomy for pancreatic benign tumors.     

Novel approach to laparoscopic resection of tumours of the distal pancreas

Background: Laparoscopic resection for small lesions of the pancreas has recently gained popularity. We report our initial experience with a new approach to laparoscopic spleen‐preserving distal pancreatectomy so that the maximum amount of normal pancreas can be preserved while ensuring adequate resection margins and preservation of the spleen and splenic vessels. Methods: Three patients underwent laparoscopic distal pancreatectomy with spleen and splenic vessel preservation over a 2‐month period. Surgical techniques and patient outcomes were examined. Results: All three patients were females, with ages ranging from 31 to 47 years. Two patients underwent resection using the conventional medial‐to‐lateral dissection as the lesion was close to the body or proximal tail of the pancreas. The third patient had a lesion in the distal tail of the pancreas and surgery was carried out in a lateral‐to‐medial manner. This new approach minimized excessive sacrifice of normal pancreatic tissue for such distally located lesions. The splenic artery and vein were preserved in all cases and there was no significant difference in clinical outcome, operative time or intraoperative blood loss. Conclusion: Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels is a feasible surgical technique with acceptable outcome. We have shown that a tailored approach to dissection and pancreatic transection based on the location of the lesion allows the maximum amount of normal pancreatic tissue to be preserved without additional morbidity. Although the conventional ‘medial‐to‐lateral’ approach is recommended for more proximal tumours of the pancreas, distal lesions can be safely addressed using the ‘lateral‐to‐medial’ approach.     

胰体尾局部病变患者腹腔镜保留脾脏的胰体尾切除术的可行性研究

目的探讨腹腔镜下保留脾脏的胰体尾切除术(LSPDP)的可行性与安全性。 方法回顾性分析2014年5月至2019年4月行腹腔镜下胰体尾切除术83例胰体尾局部病变患者,根据手术方法将行腹腔镜保留脾脏胰体尾切除术的35例患者设为LSPDP组,腹腔镜胰体尾联合脾脏切除术(LDPS)48例患者为LDPS组。数据采用SPSS24.0统计学软件分析,并发症发生率比较采用χ²检验;术中术后各项指标用( ±s)表示,采用独立样本t检验,以P<0.05为差异有统计学意义。 结果LSPDP组在术后首次排气时间优于LDPS组(P<0.05),其余手术相关指标及术后恢复情况和并发症发生率的比较,差异均无统计学意义(P>0.05)。两组患者术后随访3～65个月,成功随访的80例患者均无肿瘤复发或转移或死亡病例。 结论腹腔镜下保留脾脏的胰体尾切除术与腹腔镜胰体尾联合脾脏切除术同样安全可行,且其具有保全脾脏功能的优势。     

Distal pancreatectomy with spleen preservation in a pseudopapillary pancreatic tumor case

Pseudopapillary pancreatic tumors represent about 1-2% of all exocrine pancreatic tumors, studies in the literature about this type of tumor is limited. We present a female patient of 18 years hospitalized for nonspecific abdominal symptoms, diagnosed with corporeal pancreatic tumor approximately 3-4 cm. It takes practice surgical distal pancreatectomy with spleen preservation, pathological examination revealing a pseudopapillary pancreatic tumor. Postoperative evolution was favorable. Distal pancreatectomy with spleen preservation was indicated due to patient age.     

机器人辅助保留脾脏远端胰腺切除术围手术期指标回顾性研究

目的 探讨机器人在保留脾脏的远端胰腺切除术中的应用价值。方法 回顾性分析自2015年5月至2020年8月于中山大学附属第一医院胆胰外科行机器人辅助保留脾脏远端胰腺切除术病人的临床资料,分析围手术期相关临床病理资料及术后转归情况。结果 共有46例术前拟行机器人辅助保留脾脏远端胰腺切除术的病人入组研究,其中男性15例、女性31例,中位年龄42（32~56）岁。最终39例病人完成机器人辅助保留脾脏的远端胰腺切除术,保脾成功率为84.8%;另有6例病人行机器人辅助联合脾脏切除的远端胰腺切除术;中转开腹1例,中转率2.2%。中位手术时长为270（218~323）min。中位术中失血量为50（30~63）mL。所有病人均获得完整切除。术后6例并发临床相关胰瘘（均为B级胰瘘、无C级胰瘘）,腹腔感染4例,胃排空延迟1例,均经保守治疗后痊愈。无术后死亡病例。中位术后住院时间为8（7~11） d。术后病理学检查结果显示,24例为胰腺神经内分泌肿瘤,21例为胰腺囊性肿瘤（包括10例浆液性囊腺瘤、3例黏液性囊腺瘤、5例实性假乳头状瘤、3例导管内乳头状黏液性肿瘤）、1例为慢性胰腺炎。结论 机器人辅助保留脾脏的远端胰腺切除术是一种安全可靠的微创手术方式。