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。     

保留脾脏的胰体尾切除术17例临床分析

目的 探讨保留脾脏的胰体尾切除术在治疗胰腺远端肿瘤的疗效.方法 回顾性分析2011年1月至2014年2月施行的17例保留脾脏的胰体尾切除术患者的资料.结果 6例患者未能成功保脾,开腹与腹腔镜手术各3例;11例患者成功行保留脾脏胰体尾切除术,其中6例行开腹手术（1例术中行脾动脉修复,1例行Warshaw法保脾）;5例行腹腔镜手术成功保脾（1例中转开腹）.保脾成功组中腹腔镜与开腹手术后发生胰漏各2例,均经保守治疗痊愈.患者均获得随访,随访时间2个月到3年,均无脾血管栓塞、脾梗死、肿瘤复发.结论 保留脾脏的胰体尾切除术是安全可靠的,值得临床进一步推广.     

腹腔镜下保留脾脏的胰体尾切除术4例

目的：探讨在腹腔镜下,对胰体尾部肿瘤患者进行保留脾脏的胰体尾切除术的可行性与安全性。方法：我院2008年2月—2010年4月对4例胰体尾良性病变施行腹腔镜下保留脾脏的胰体尾切除术。结果：4例手术均顺利完成,平均手术时间为235（115～305）min,术中平均出血量为200（100～450）mL,术后平均住院时间为12.8（10～21）d,术后有1例患者产生胰瘘,延迟拔管,治愈后出院。术后病理诊断为胰体尾浆液性囊腺瘤2例,黏液性囊腺瘤1例,胰岛细胞瘤1例。结论：对胰体尾部的良性病变行腹腔镜下保留脾脏的胰体尾切除术是微创并安全的,具有恢复快、并发症少等优点。     

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。     

保留脾脏的腹腔镜胰体尾切除术治疗经验

目的 总结腹腔镜保留脾脏的胰体尾切除术的经验。方法 2003年11月和2004年12月分别对2例胰体尾囊性占位患者施行保留脾脏的腹腔镜胰体尾切除术。结果 2例手术均顺利完成,手术时间分别为220min和190min,术中出血为450ml和350ml,术后住院时间为6d和5d,术后无胰漏等并发症发生。病理诊断2例均为胰腺浆液性囊腺瘤。分别随访18个月和5个月,术前症状均得到明显缓解,未见复发。结论 对胰体尾部良性病变行保留脾脏的腹腔镜胰体尾切除术是安全可行的,具有创伤轻、恢复快、并发症少等优点。     

保留脾血管的腹腔镜胰体尾切除术

目的:探讨保留脾脏血管腹腔镜胰体尾切除术的可行性与安全性。方法:回顾分析2011年3月至2014年7月为38例患者行保留脾血管腹腔镜胰体尾部肿瘤手术的临床资料。结果:手术时间116~295 min,平均(170.5±50.2)min;术中失血量15~565 ml,平均(112.3±33.6)ml;均未输血。病理检查结果示胰腺导管腺癌11例,浆液性囊腺瘤6例,黏液性囊腺瘤9例,黏液性囊腺瘤局部癌变2例,胰岛素瘤4例,实性假乳头状肿瘤6例。术后3例发生胰漏,经保守治疗好转。余者术后均恢复顺利,无并发症发生,术后平均住院(7.36±2.13)d。结论:腹腔镜保留脾脏血管胰体尾切除术是有效治疗远端胰腺肿瘤的新术式,具有微创优势,安全、可行。     

保留脾脏胰体尾切除术的临床探讨

目的探讨保留脾脏胰体尾切除术的可行性和安全性。方法总结2006年2月—2010年8月1 6例胰体尾部良性和交界性病变实行了保留脾脏的胰体尾切除术的临床资料,其中15例为保留脾脏血管胰体尾切除,1例为切断脾血管保留脾脏胰体尾切除。结果术后发生胰瘘9例,切口感染1例,腹腔出血3例(其中1例为胰瘘后发生出血),胸腔积液2例。9例胰瘘者,8例经非手术治疗,3~7周痊愈,1例并发出血后行数字减影脾动脉栓塞止血,第17周痊愈。另2例腹腔出血者,1例经非手术治疗治愈,1例二次手术,见脾静脉分支出血,结扎止血。全组无死亡病例。结论胰体尾部良性和交界性肿瘤,可首先选择保留脾脏的胰体尾切除术,手术安全,疗效好。     

脾血管优先技术在腹腔镜保留脾脏胰体尾切除术中的应用

[摘 要] 目的 探讨脾血管优先技术在腹腔镜保留脾脏胰体尾切除术中的应用。方法 回顾性分析2011年6月至2017年12月浙江省人民医院和浙江省长兴县人民医院采用腹腔镜保留脾脏胰体尾切除术治疗的58例胰体尾良性或交界性占位病变患者的临床资料。结果 中转开腹2例;余56例均顺利完成手术,其中保留脾动、静脉的保脾胰体尾切除术（Kimura法）53例,离断脾血管、保留胃短血管的保脾胰体尾切除术（Warshaw法）3例。手术时间65～220（160±30）min,出血量30～500（100±25）mL,术后住院时间5～21（8±5）d。术后并发生化瘘15例,B级胰瘘2例,C级胰瘘1例,腹腔出血1例,腹腔脓肿2例,肺部感染2例。术后病理诊断为胰腺内分泌肿瘤8例,胰腺导管内乳头状黏液瘤10例,胰腺实性假乳头状瘤12例,黏液性囊腺瘤10例,浆液性囊腺瘤13例,慢性胰腺炎肿块5例。结论 脾血管优先技术具有简便、安全的特点,有助于主动选择术式和规划手术路径,提高腹腔镜胰尾切除术的安全性和保脾成功率。     

腹腔镜胰体尾切除30例报告

目的探讨腹腔镜胰体尾切除的安全性和可行性。方法 2013年1月~2016年6月对30例胰体尾占位性病变施行腹腔镜下胰体尾切除。术中定位肿物及胰腺切线,充分游离胰颈并应用Endo-GIA切断胰腺,根据肿物性质及肿物与脾血管关系决定是否保留脾脏。结果 4例因脾血管出血难以控制中转开腹。行腹腔镜保留脾脏胰体尾切除15例,其中保留脾血管的保脾胰体尾切除(Kimura法)10例,手术时间210~260 min,(232±14)min,术中出血量120~200 ml,(165±21)ml;不保留脾血管的保脾胰体尾切除(Warshaw法)5例,手术时间110~170 min,中位手术时间135 min,术中出血量50~130ml,中位出血量80 ml。胰体尾及脾切除11例,手术时间95~190 min,(137±31)min,术中出血量30~150 ml,(83±41)ml。术后住院时间7~22 d,(12.2±2.4)d。术后病理:黏液性囊腺瘤9例,实性假乳头状瘤7例,神经内分泌肿瘤6例,浆液性囊腺瘤3例,胰腺囊肿3例,导管内乳头状黏液瘤1例,异位脾脏1例。术后胰漏发生率36.7%(11/30),部分脾梗死1例。21例随访中位时间15个月(6~36个月),未见肿瘤复发。结论对于胰体尾良性、交界性或低度恶性肿瘤,选择腹腔镜下胰体尾切除安全可行,创伤小,恢复快。     

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.     

Open and Laparoscopic Spleen-preserving,Splenic Vessel-preserving Distal Pancreatectomy: Indications and Outcomes

Background  Spleen-preserving distal pancreatectomy has been described lately in order to reduce the risks associated with splenectomy. The aim of this study is to report a series of open and laparoscopic distal pancreatectomies with splenic vessel preservation. Methods  From June 2001 to April 2007, 11 spleen-preserving distal pancreatectomies were performed, utilizing open and laparoscopic techniques. The main variables recorded were demographics, intra- and postoperative complications, and final pathology results. Results  All 11 spleen-preserving distal pancreatectomies were performed successfully. Laparoscopic resection was possible in seven patients. Postoperative morbidity consisted of one pancreatic fluid collection. The overall incidence of pancreatic leak was 18%. The final pathology revealed serous cystadenoma in 36% of the cases, neuroendocrine tumor in two cases, three mucinous cystadenomas, one carcinoid tumor, and one intrapancreatic spleen. With a median follow-up of 26 months, no splenic vein thrombosis was detected. Conclusions  Open or laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation is a feasible and safe procedure. In selected cases of cystic lesions and low grade neoplasms, distal pancreatectomy with splenic preservation is possible. Presented at: 2007 American Hepato-Pancreato-Biliary Association. April 19–22, 2007, Las Vegas, NV, USA.     

Laparoscopic extended (subtotal) distal pancreatectomy with resection of both splenic artery and vein

Background

Spleen-preserving distal pancreatectomy can be performed safely and effectively by resecting both splenic vessels (Warshaw procedure) [1–4]. This simplified spleen-preserving technique might also be applied to minimally invasive distal pancreatectomy of benign and borderline malignant tumor [5, 6].

Methods

Although the conservation of both splenic vessels is paramount to preserving the spleen during laparoscopic distal pancreatectomy, preservation of the splenic vessels is not always possible, especially under the following conditions: (1) relatively large tumor, (2) associated with chronic pancreatitis, (3) tumor abutting splenic vascular structures, and (4) bleeding during the splenic vessel conserving procedure, which are potential indications of laparoscopic extended Warshaw procedure. Patient preparation and position was the same as that described in our previous study [7].

Results

During the study’s time period, 38 consecutive patients underwent laparoscopic spleen-preserving distal pancreatectomy. Of those, five patients underwent a laparoscopic extended Warshaw procedure, which all included among 16 patients of extended distal pancreatectomy by dividing the pancreas at the pancreatic neck. All patients were women with a median age of 55 (range, 38–75) years. Median total operation time and blood loss were 215 (range, 200–386) minutes and 100 (range, 0–300) ml, respectively. The median length of hospital stay was 8 (range, 5–15) days. All of postoperative complications (two grade A and two grade B postoperative pancreatic fistula; one grade A bleeding) were able to be treated conservatively. During the median follow-up period of 11 (range, 7–42) months, one focal splenic infarction and one gastric varix were noted; however, no clinically significant complications were reported.

Conclusions

Laparoscopic spleen-preserving extended distal pancreatectomy with resection of both the splenic vessels is feasible and safe [8]. This surgical technique is thought to increase the chance of preservation of the spleen with minimally invasive distal pancreatectomy in well-selected benign or borderline malignant tumor of the distal pancreas.     

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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.     

保留脾血管的腹腔镜胰体尾切除术安全性初探

目的 探讨保留脾血管腹腔镜胰体尾切除术（Kimura法）的安全性。方法 回顾性分析2015年1月至2019年6月内蒙古医科大学附属医院5例行保留脾血管腹腔镜胰体尾切除术患者的临床资料。结果 5例手术均顺利完成,无中转开腹,无围手术期死亡;病理证实均为良性或者低度恶性肿瘤;手术时间3.0～8.5 h,平均（5.7±1.82）h;出血量50～300 mL,平均（130±98.49）mL。术后第4～12 d拔管,第7～14 d出院,术后平均住院时间（9.52±2.21）d。术后随访,无肿瘤复发。A级胰瘘1例。结论 围手术期精心准备,初期尝试行保留脾血管的腹腔镜胰体尾切除术是安全可行的。     

Laparoscopic spleen-preserving distal pancreatectomy for solid pseudopapillary tumor with conservation of splenic vessels in a child

Laparoscopic spleen-preserving distal pancreatectomy (LSDP) with conservation of the splenic vessels is gaining acceptance as a reliable treatment for selected patients with low-grade malignant tumors of the pancreas in adults. The operation requires advanced laparoscopic skills to safely divide the fine branches of the splenic vessels. Laparoscopic spleen-preserving distal pancreatectomy with conservation of splenic vessels is rarely reported in children. We describe a 12-year-old girl with solid pseudopapillary tumor in the body of the pancreas that was successfully treated with LSDP, preserving the splenic vessels. The postoperative course was uneventful, and the functional and aesthetic results were satisfactory. Laparoscopic spleen-preserving distal pancreatectomy with conservation of splenic vessels may be a safe and feasible treatment option for children with pancreatic disease.