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。     

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。     

保留脾脏的胰体尾切除术

目的 行胰体尾切除对保留脾脏。方法 回顾性总结８年来保留脾脏的胰体尾切除术１９例，全组根据术中所见分为脾动静脉连同胰体尾切除及保留脾动脉，脾脏的胰体尾切除，１９例患者分别为胰腺囊腺瘤８例，胰腺假性囊肿２例，胰岛素瘤３例，胰腺外伤６例。结果术后观察及随访主要指标为白细胞吞噬试验，脾脏ＣＴ，Ｂ超及＾９９ｍＴｃ扫描等，除１例术后脾脏一过性血供不良外，其余１８例术后效果均满意。结论 作胰体尾切除时可保留     

保留脾脏的胰体尾切除术

1913年Ｍａｙｏ在胰体尾部肿瘤手术中首创远端胰腺切除术 ,同时合并脾脏切除 ,并作为标准术式流传至今。但随着大量基础研究的深入和临床实践经验的积累 ,“脾脏不再是可有可无的器官 ,而是具有重要保护功能的免疫器官”这一概念已被广大临床医师所接受 ,无辜性脾切除应尽量避免。越来越多的手术病例证实保留脾脏的胰体尾切除术在技术上是完全可行的。一、保留脾脏的胰体尾切除术的解剖学基础胰体尾 -脾区解剖结构毗邻紧密 ,脾动静脉为胰体尾和脾脏解剖联系的纽带。由于脾动静脉与胰体尾、脾门与胰尾的紧密联系 ,胰体尾与脾脏常视为一个解剖…     

腹腔镜保脾胰体尾切除八例的手术经验

目的总结保留脾脏腹腔镜胰体尾切除术的临床经验与手术技巧。方法自2003年11月至2008年2月,我们对8例胰体尾部良性占位病变患者施行保留脾脏腹腔镜胰体尾切除术。结果本组8例均在腹腔镜下完成,其中1例合并胆囊切除,1例合并右肾上腺肿瘤切除,1例合并子宫肌瘤挖出、左卵巢畸胎瘤挖出,1例合并子宫肌瘤挖出。本组手术时间120—290min,出血量150—600ml。术后住院时间3～9d,无胰漏发生。术后病理诊断：潴留性囊肿2例,浆液性囊腺瘤1例,黏液性囊腺瘤2例,上皮性囊肿2例,先天性囊肿1例。随访9～60个月,症状消失,未见复发。结论对于胰体尾部良性病变,可行保留脾脏的胰体尾部切除,对拥有丰富高级腹腔镜手术经验的术者,开展保留脾脏的腹腔镜胰体尾切除术是安全可行的。     

腹腔镜保留脾脏胰体尾切除术的关键技术

腹腔镜保留脾脏胰体尾切除术适用于胰体尾部良性或低度恶性病变,避免了脾切除术后近、远期并发症,手术方式包括保留脾动静脉的Kimura手术和切除脾动静脉主干、保留胃网膜左血管等侧枝循环的Warshaw手术。腹腔镜下Kimura手术视野清晰,安全可行,术后并发症发生率低,应为保脾胰体尾切除手术的首选。术前检查或术中探查可疑为浸润性恶性病变或病灶与脾血管、脾门关系密切者,应果断放弃保脾术式,改行胰体尾联合脾切除术。     

保留脾脏及供应血管胰体尾切除治疗胰腺断裂伤18例报道

目的 探讨保留脾脏胰体尾切除治疗胰腺体尾部断裂伤的临床可行性和效果.方法 对扬州大学临床医学院2008年3月-2012年11月实施保留脾脏胰体尾切除治疗胰腺断裂伤18例患者的临床资料进行回顾性分析评价.结果 18例患者均能顺利施行保留脾脏胰体尾切除.手术时间152 ～188 min,平均172 min;术中出血量155 ～356 mL,平均191 mL;住院时间为13～19 d,平均15 d.无术后大出血、胰漏、腹腔感染等严重术后并发症.结论 保留脾脏胰体尾切除治疗胰腺体尾部断裂伤减少了“无辜性脾切除”,是一种保全脏器功能效果较好、安全可行的手术方式.     

胰腺横断伤4例报告

随着交通业的迅猛发展,胰腺损伤的发生率明显增多,约占腹部损伤的0.2%～6%眼1演,现就对4例胰腺横断伤进行报道如下。1临床资料1.1一般资料:本组4例均为男性,分别为车祸、坠落伤所致,3例术前出现失血性休克,4例均合并其他脏器损伤,均为胰腺颈部横断伤。1例行近端缝合闭锁、胰体空肠吻合术,2例行胰腺体尾切除加脾脏切除,1例行胰体尾切除,结扎脾脏动静脉,保留脾脏。3例胰体尾切除者,血糖轻度升高,术后4例均恢复良好。2.2治疗2.2.1手术处理:一般认为保留20%以上的胰腺组织不致引起胰腺内外分泌的不足眼2演。胰头部、颈部横断伤时的手术方式必须…     

腹腔镜胰体尾切除术选择策略临床研究（附56例报告）

目的 探讨腹腔镜胰体尾切除术治疗胰体尾占位性病变的术式选择策略和操作技巧。 方法 回顾性分析浙江省人民医院和漳州市人民医院2012年4月至2014年6月采用腹腔镜胰体尾切除术治疗的56例胰体尾占位性病变病人的临床资料。结果 56例中中转开腹3例（5.4%）,余53例（94.6%）均顺利完成手术。联合脾脏切除、保留脾血管保脾（Kimura法）和离断脾血管保脾（Warshaw法）的腹腔镜胰体尾切除术分别为31例（58.5%）、19例（35.8%）和3例（5.7%）。手术时间70～230（170±35）min,出血量50～310（110±34）mL,术后住院时间5～35（9±6）d。术后并发A级胰瘘13例（23.2%）,B级胰瘘1例（1.8%）、腹腔脓肿1例（1.8%）、肺炎2例（3.6%）。结合影像学和术后病理学检查报告分析,中转开腹、联合脾脏切除和Warshaw法：胰腺导管腺癌12例、肿瘤直径＞
5 cm的交界性胰腺肿瘤23例和慢性胰腺炎2例。Kimura法：均为肿瘤直径＜5 cm的良性或交界性胰体尾病变。良性或交界性胰体尾病变保脾率50.0%（22/44）。 结论 根据胰腺肿瘤性质、大小和部位,以及脾动、静脉与胰腺或胰腺肿瘤的关系,主动选择术式和规划手术路径,有助于提高腹腔镜胰体尾切除术的安全性和保脾率。     

腹腔镜胰体尾切除32例体会

目的总结腹腔镜胰体尾切除术(laparoscopic distal pancreatectomy,LDP)的手术体会,探讨其治疗胰体尾肿物的可行性和临床应用价值。 方法回顾性分析2016年1月至2019年12月就诊于沧州市人民医院肝胆外科诊断为胰体尾部占位性病变,行LDP的32例患者的临床资料。其中男12例、女20例,年龄13～75岁,平均(41.3±3.7)岁;术中根据肿物性质、肿物与脾血管解剖关系以及术中脾脏具体的损伤程度决定是否保留脾脏。 结果本研究纳入的32例胰体尾部占位性病变的患者中,仅有1例患者因肿瘤较晚侵犯了部分横结肠所以选择了中转开腹行胰腺尾部肿瘤＋部分横结肠切除术,其余31例患者均顺利在腹腔镜下完成胰体尾肿瘤切除术。其中行保留脾脏的腹腔镜胰体尾切除术(spleen preserving laparoscopic distal pancreatectomy,SPLDP)12例[其中应用Kimura法(脾血管保留) 8例、应用Warshaw法(脾血管切除)4例],腹腔镜联合脾脏胰体尾切除术20例。平均手术时间(252 ±75)min,平均术中出血量(162±51)ml;平均术后住院时间(11.6±3.2)d。32例胰体尾占位性病变患者的术后病理分别为：实性假乳头状瘤10例、浆液性囊腺瘤6例、黏液性囊腺瘤4例、神经内分泌肿瘤4例、腺癌3例、导管内乳头状黏液瘤3例、胰腺假性囊肿1例、胰尾部外伤性损伤1例。术后并发症：胰瘘10例,该10例患者通过保证创面通畅引流,同时给予抗感染、抑制胰液分泌等对症治疗后好转痊愈出院;乳糜漏1例,术后通畅引流,逐渐退管、闭管后好转痊愈出院;腹腔出血1例,通过给予生长抑素、止血药等保守治疗后痊愈出院;术后新发糖尿病5例,术后内分泌科随诊控制血糖。 结论LDP治疗胰体尾肿瘤是安全有效的,但是需要具有丰富腹腔镜手术经验的术者实施,术前综合精准评估制订良好的手术策略,术中熟练的手术操作技巧是提高LDP安全性、降低术后并发症的关键。     

四种保留器官的胰腺切除术式的指征、技术和疗效

目的 探索四种保留器官的胰腺切除术式在治疗胰腺良性及低度恶性肿瘤中的疗效.方法 回顾性总结1990年1月至2010年5月施行的72例保留器官胰腺切除术的手术经验及疗效,男性24例,女性48例,年龄15～68岁,平均46岁.其中行保留十二指肠的胰头切除术(DPRHP)9例,行保留脾脏的胰体尾切除术(SPDP)29例,行胰腺中段切除术11例,行胰腺头体部巨大肿瘤摘除术23例.结果 行DPRHP的9例患者中,术后并发胰瘘、胆瘘各1例,均经保守治疗愈合.行SPDP的29例患者中,术后并发胰瘘3例,未发生迟发性脾梗死.行胰腺中段切除的11例患者中,术后合并胰肠吻合口出血1例,经手术治疗治愈.行胰腺头体部巨大肿瘤摘除术的15例非功能性胰岛细胞瘤患者中,术后并发胰瘘5例,3例于术后6、12、16个月出现肝转移;行肿瘤摘除术的8例黏液性囊腺瘤患者中,术后并发胰瘘2例.结论 保留器官的胰腺切除术可明显减轻手术创伤,疗效与传统术式相同,应作为胰腺良性或低度恶性肿瘤的首选术式.     

胰腺浆液性微囊腺瘤的不典型临床影像特点

目的:探讨胰腺浆液性微囊腺瘤的不典型临床影像表现及诊治策略。方法:回顾2008年7月至2019年10月北京协和医院收治的11例术前临床影像表现不典型的胰腺浆液性微囊腺瘤的患者资料,总结其临床表现、CT/MRI特点、术前临床诊断、手术方法、术后情况等。结果:共纳入11例不典型微囊腺瘤患者,中位年龄50(46～66)岁,女...     

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目的探讨胰腺神经内分泌肿瘤伴肝转移的生物学特征及临床特点、组织学特点、治疗方法及预后。方法回顾性分析复旦大学附属中山医院1999年1月至2011年6月收治的16例胰腺神经内分泌肿瘤伴同时性和异时性肝转移病例的临床资料。结果 16例中男5例,女11例。平均年龄48岁。肿瘤位于胰头5例,胰体5例,胰尾6例。行胰十二指肠切除术5例,其中1例因术后出现肝转移再次手术行转移灶切除。行胰体尾和脾切除术7例,其中2例同时行肝转移灶切除。3例行胰腺部分切除术,其中2例同时行肝转移灶切除。1例行穿刺活检术。16例中同时性肝转移11例,5例为异时性肝转移,15例为多发性肝转移。10例术后行介入、射频消融、生长抑素和化疗。病理检查:瘤体平均7.74cm×6.56cm×5.02cm。6例有淋巴结转移,11例侵犯神经,1例侵犯十二指肠、胆总管。结论对于胰腺神经内分泌肿瘤伴肝转移病例应制定合理、积极有效的综合治疗方案,对提高临床治愈率、改善病人预后具有重要的意义。     

Cystic pancreatic neuroendocrine tumors: Is preoperative diagnosis possible?

Pancreatic neuroendocrine tumors rarely undergo cystic degeneration leading to a radiologic appearance, which is often interpreted as a pancreatic mucinous cystadenoma or pseudocyst. We reviewed our experience with 38 neuroendocrine tumors, four of which were cystic, and 24 other cystic pancreatic tumors (mucinous cystadenoma [n = 5], cystadenocarcinoma [n = 6], serous cystadenoma [n = 3], solid/cystic papillary neoplasm [n = 3], intraductal papillary mucinous tumor [n = 6], and mucinous adenocarcinoma [n = 1]) managed operatively between 1990 and 2000. This review was undertaken to identify clinical and pathologic features useful for preoperative diagnosis of cystic neuroendocrine tumors. Two of the four patients with cystic neuroendocrine tumors presented with abdominal pain, one patient was asymptomatic, and one patient had hypoglycemia. Three of the four cystic neuroendocrine tumors were identified by CT scan, and none were biopsied preoperatively. Preoperative diagnoses included mucinous cystadenoma in two patients (n = 2), pancreatic cystic neoplasm in one patient, (n = 1) and insulinoma in one patient (n = 1). All four cystic neuroendocrine tumors were benign and were completely resected (distal pancreatectomy [n = 2], enucleation [n = 2]). Cystic neuroendocrine tumors are difficult to diagnose preoperatively because the majority of these tumors are nonfunctional, and CT does not differentiate these tumors from other cystic neoplasms. Cystic neuroendocrine tumors represent a subgroup of pancreatic cystic and neuroendocrine tumors with malignant potential. Their high resectability rate further supports the role of surgical exploration and resection in the treatment of pancreatic cystic neoplasms. Presented at the Third Americas Hepatopancreatobiliary Congress, Miami, Fla., February 22–25, 2001.     

Endovascular covered stenting for visceral artery pseudoaneurysm rupture: report of 2 cases and a summary of the disease process and treatment options

We present 2 cases of hemorrhage from a visceral artery pseudoaneurysm, managed successfully with endovascular covered stent placement. The first case was a 59-year-old man, 3 months after a laparoscopic distal pancreatectomy for adenoma, presenting with diffuse abdominal pain. The patient was evaluated with a computed tomography scan revealing a splenic artery pseudoaneurysm (PA) bleeding into a pancreatic pseudocyst. He was emergently taken to the angiography suite where a covered stent was deployed at the level of splenic artery PA. The second case was a 52-year-old woman with recurrent left retroperitoneal mass 5 years after distal pancreatectomy and splenectomy for a nonfunctional neuroendocrine tumor. She underwent resection of the mass in the left upper quadrant. Postoperative course was complicated by hematoma, abscess formation, reexploration, and repair of the duodenotomy and the portal vein. Subsequently, she was noted to have intermittent gastrointestinal hemorrhage, which prompted an angiogram revealing a hepatic artery PA that was repaired with a covered balloon-expandable stent. A completion angiogram was obtained in each case demonstrating exclusion of the PA. Our experience with these 2 cases supports the notion that endovascular covered stenting is a safe and effective therapy for exclusion of visceral artery aneurysm.     

Laparoscopy-assisted spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein

Herein, we report the successful performance of a laparoscopy-assisted spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for a patient with pancreatic cystadenoma, as a minimally invasive procedure with the preservation of function. The laparoscopy-assisted distal pancreatectomy procedure involved detaching the spleen and the distal pancreas from the retroperitoneum by a hand-assisted procedure, removing them from the peritoneal cavity through a small incision, and detaching the distal pancreas by ligating and transecting the short gastric artery and vein and the branches of the splenic artery and vein, while the spleen and main splenic artery and vein were preserved under direct view. The pancreatic parenchyma was transected with a stapling device (TL-30), and continuous suturing was added to the resected margin. The patients postoperative course was uneventful; the patient started to eat and walk on postoperative day 2 and was discharged on day 8. It is considered that the combination of hand-assisted and laparoscopy-assisted distal pancreatectomy, with conservation of the splenic artery and vein, is a minimally invasive and clinically useful technique for treating tumors of cystic disease of the pancreas with low-grade malignant potential, or benign solitary neuroendocrine tumors.     

Resection of pancreatic neuroendocrine tumors: results of 70 cases

HYPOTHESIS: Neuroendocrine tumors of the pancreas can be managed surgically with excellent outcomes. DESIGN: Retrospective case series. SETTING: Academic medical center. PATIENTS: Seventy consecutive patients who underwent resection for pancreatic neuroendocrine tumors between January 1, 1990, and December 31, 2005. INTERVENTIONS: Pancreaticoduodenectomy, distal pancreatectomy, or enucleation. MAIN OUTCOME MEASURES: Postoperative morbidity, mortality, and long-term survival. RESULTS: Of the 70 patients, 50 (71.4%) had nonfunctional tumors. Thirty-seven patients (52.9%) had neuroendocrine carcinomas and 13 (18.6%) had benign islet cell neoplasms. Twenty patients had functional tumors. Of these 20 patients, 16 had insulinomas, 2 had glucagonomas, and 2 had gastrinomas. Twenty-seven patients underwent pancreaticoduodenectomy, 32 had distal pancreatectomy, and 11 underwent enucleation. Patients undergoing enucleation as compared with those not undergoing enucleation were younger (mean age, 39 vs 51 years, respectively; P = .009) and had smaller tumors (mean tumor size, 2 vs 5 cm, respectively; P<.001). Postoperative complications occurred in 13 patients (48.1%) after pancreaticoduodenectomy, in 4 patients (12.5%) after distal pancreatectomy, and in 0 patients after enucleation. There were no perioperative mortalities. With a median follow-up of 50 months, the 5-year actuarial survival for the patients with malignant neuroendocrine carcinomas (n = 37) was 77%, and all of the patients with functional tumors are alive. The presence of lymphovascular invasion closely approached significance when survival was evaluated (P = .06). Lymph node status, perineural invasion, and liver metastasis did not impact survival. CONCLUSIONS: This single-institutional case series demonstrates that pancreatic neuroendocrine tumors can be safely resected without mortality and with minimal morbidity. The presence of lymphovascular invasion can be used to classify neuroendocrine tumors as malignant, and this appears to predict survival. Patients with malignant tumors can expect long-term survival even in the setting of metastatic disease.     

保留器官的胰腺切除术治疗胰腺良性或低度恶性肿瘤：单中心66例报告

目的:探讨保留器官的胰腺切除术治疗胰腺良性或低度恶性肿瘤的临床价值。方法:回顾性分析南昌大学第一附属医院普通外科2009年1月—2016年12月间66例胰腺良性或低度恶性肿瘤施行保留器官的胰腺切除术患者的临床资料。其中胰岛素瘤34例,实性假乳头状瘤16例,浆液性囊腺瘤9例,导管内乳头状黏液瘤4例,无功能性神经内分泌肿瘤、副神经节瘤和黏液性囊腺瘤各1例;肿瘤局部切除术34例,中段胰腺切除术10例,保留脾脏的胰体尾切除术13例,保留幽门的胰十二指肠切除术6例,保留十二指肠的胰头切除术3例。结果:平均手术时间为(163.6±77.4)min,平均术中出血量为(234.4±242.7)mL,平均术后住院时间为(11.3±8.1)d。总体腹部并发症、残胰生化漏、B/C级胰瘘、腹腔内感染、胃排空延迟和腹腔内出血发生率分别为36.4%、15.2%、10.6%、6.1%、3.0%和1.5%。无再手术和手术相关死亡。术后平均随访(47.2±25.6)个月,新发糖尿病和需胰酶替代治疗发生率分别为3.1%(排除34例胰岛素瘤患者)和1.5%,无肿瘤复发和转移。结论:保留器官的胰腺切除术能最大程度保留胰腺实质和周围脏器,避免胰腺的内外分泌或脾脏功能的过度丧失,可作为胰腺良性或低度恶性肿瘤的首选术式。     

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。     

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??Diagnosis and treatment of solid-pseudopapillary tumor of pancreas ZHANG Ren-chao*, MOU Yi-ping, JIANG Chao-hui, et al??*Department of General Surgery, the 117th Hospital of PLA, Hangzhou 310013, China Corresponding author??MOU Yi-ping??E-mail??mouyiping@yahoo.com.cn Abstract Objective To analyze the diagnosis and treatment of solid-pseudopapillary tumor of pancreas??SPT????Methods The clinical data of 13 cases of SPT admitted from January 1999 to October 2007 in the Department of General Surgery of Sir Run Run Shaw Hospital (Medical College of Zhejiang University) and Department of General Surgery of the 117th Hospital of the PLA were analyzed retrospectively??Results All the cases were female with the mean age of 32 years old??SPT had no specific clinical symptoms??Abdominal pain and space occupying symptoms were the mostly symptoms??All the cases received operation??Operative procedure included pancreaticoduodenectomy in 6 cases, pancreatic neck segmentectomy in 1 case, distal pancreatectomy in 1 case, distal pancreatectomy with splenectomy in 2 cases, laparoscopic distal pancreatectomy with splenectomy in 2 cases , distal pancreatectomy, sigmoid colectomy and ethanol injection of liver nodulars in 1 case??Twelve cases recovered successfully after the operation. One case received distal pancreatectomy suffered from postoperative biliary and pancreatic fistula??Ten cases were followed up without tumor recurrence??Conclusion SPT is a special type of pancreatic tumor with low degree malignancy, affecting in young women predominantly??Aggressive surgery could get good prognosis??