腹腔镜保留脾脏和脾血管的胰体尾切除术

With the maturation of laparoscopic surgical technology and the development of surgical instruments,the scope of application for laparoscopie surgery has expanded constantly in recent years.It is now p...     

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。     

腹腔镜保留与不保留脾脏的胰体尾切除术治疗胰体尾病变的效果分析

目的:对比腹腔镜保留脾脏(LSPDP)与不保留脾脏的胰体尾切除术(LDPS)治疗胰体尾病变的临床效果。方法:分析2011年3月至2018年6月行腹腔镜胰体尾切除术的31例胰体尾占位患者的临床资料。按手术方式将患者分为保留脾脏的胰体尾切除组(LSPDP组,n=14)与脾脏切除组(LDPS组,n=17),对比两组患者围手术期及随访结果。结果:两组均无围手术期死亡病例。LSPDP组肛门排气时间、术后住院时间优于LDPS组,差异有统计学意义(P<0.05);两组术中出血量、手术时间、胰瘘发生率、门静脉血栓发生率、腹腔积液发生率差异无统计学意义(P>0.05)。31例患者术后随访6～81个月,平均(28.26±19.21)个月,无肿瘤复发转移。结论:由经验丰富的腹腔镜外科医生有选择性地行腹腔镜保留脾脏的胰体尾切除术治疗胰腺良性或交界性肿瘤是安全、可行的。     

保留脾脏的胰体尾切除术的临床研究

目的 探讨保留脾脏的胰体尾切除术的安全性、可行性及应用价值.方法 回顾性分析2009年10月至2013年6月因胰体尾良性及低度恶性肿瘤行胰体尾切除术38例患者的临床资料,根据手术方式分为保留脾脏胰体尾切除术组（SPDP组,18例）和联合脾脏切除术组（DPS组,20例）.比较两组手术时间、术中出血量、围术期血小板计数、术后住院观察时间、并发症发生率及死亡情况.结果 SPDP组与DPS组相比,术后第3天及第7天血小板计数较低且基本在正常范围内[第3天（187.8±50.4）×10^9/L与（253.9±54.5）×10^9/L,第7天（202.7±48.0）×10^9/L与（356.4±63.4）×10^9/L],差异均有统计学意义（P〈0.01）;住院观察时间短[（11.6±2.2） d与（14.1±2.3） d],差异有统计学意义（P〈0.01）.手术时间[（188.6±20.1） min与（180.8±29.8） min]、术中出血量[（212.2±120.9） ml与（224.0±113.3） ml]、术后并发症发生率（16.7%与30.0%）等比较,差异均无统计学意义（P〈0.05）.结论 对于胰体尾部良性及低度恶性肿瘤保留脾脏的胰体尾切除术是安全、可行的,且可降低深静脉血栓形成的风险.     

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。     

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。     

腹腔镜保脾胰体尾切除术治疗胰体尾癌的可行性探讨

目的:探讨腹腔镜保脾胰体尾切除术治疗胰体尾癌的可行性。方法:回顾性分析2017年2月—2018年10月郑州大学附属洛阳中心医院行腹腔镜保脾胰体尾切除术治疗的9例胰体尾癌患者的临床资料。结果:全组9例患者手术均成功,无中转手术。手术时间140～320min,出血量150～550mL,无非计划二次手术,术后住院时间5～14d。术后发生A级胰瘘1例,B级胰瘘1例,经治疗后痊愈。患者均无术后大出血、脾坏死、C级胰瘘等重大并发症,随访1～20个月,未见肿瘤复发。全组患者无死亡。结论:LSPDP治疗低恶性的胰体尾癌是安全可行的,远期效果还需进一步累计资料进行评估。     

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。     

Kimura法腹腔镜胰体尾切除术中脾血管分离技巧探讨

目的:探讨Kimura法(腹腔镜下保留脾血管的胰体尾切除术)中脾血管分离的技术要点。方法:回顾性分析2015年1月—2016年12月采用Kimura法实施的18例胰腺体尾部切除患者的临床资料。结果:18例均顺利完成Kimura手术,手术时间136~220 min,平均170 min,出血量50~450 mL,平均180 mL,术后平均住院时间6~21 d,平均9.6 d,术后病理均为胰腺良性或交界性肿瘤。10例患者术中使用5-0的Prolene线缝合脾静脉或脾动脉裂口。术后主要并发症为腹腔胰瘘,其中A级胰瘘8例(44.4%),B级胰瘘2例(11.1%),均经保守治疗治愈。结论:Kimura法治疗胰体尾部良性及交界性肿瘤是安全可行的,完善的术前准备、娴熟的腔镜下操作技术和配合能力,尤其是掌握脾血管分离和缝合技巧是完成手术的关键。     

全腹腔镜胰体尾切除术研究进展

[摘 要] 腹腔镜技术在胰腺外科的应用相对比较缓慢,且更具挑战性。随着腔镜手术器械的发展及术者手术经验的积累,腹腔镜胰体尾切除术在越来越多的肝胆胰诊疗中心相继开展,腹腔镜保留脾脏的胰体尾切除术被大多胰腺外科医生青睐。本文就腹腔镜保留脾脏的胰体尾部切除术的适应证和禁忌证、Warshaw与Kimura两种术式的优劣及手术并发症的防治等研究进展进行综述。     

Laparoscopic distal pancreatectomy with splenic preservation

Background The technique of distal pancreatectomy has been well described, both with en bloc resection of the spleen and with splenic preservation. Splenic preservation during pancreatic tail resection is desirable when oncologically appropriate, yet it is technically challenging, particularly with laparoscopic approaches. Skeletonization of the splenic artery and vein is associated with longer operative times and greater potential for bleeding. The authors report their experience with splenic preservation during laparoscopic pancreatic resection using ligation of the splenic vessels and preservation of the short gastric vessels. Methods A retrospective chart review was performed for all patients who underwent attempted laparoscopic pancreatic resection at Duke University Medical Center from July 2002 to October 2005. Charts were analyzed for demographic information, length of hospital stay, conversion, splenic preservation, and postoperative complications. Results A total of 12 laparoscopic distal pancreatic resections were attempted for three men and nine women with a mean age was 55.8 years (range, 33–74 years). All 12 patients underwent distal pancreatectomy, 8 with splenic preservation. The spleen was removed from three patients using splenic hilar lesions that prevented splenic salvage. One patient required splenectomy secondary to more than 50% ischemia of the spleen. No patients with preoperatively diagnosed malignancy underwent splenic salvage. The final pathologic diagnosis included neuroendocrine tumors (n = 2), cystic serous (n = 4) and mucinous (n = 2) neoplasms, intraductal papillary mucinous neoplasm (IPMN) (n = 1), pancreatitis (n = 2), and adenocarcinoma (n = 1). Two patients underwent conversion to open surgery for thickened parenchyma secondary to chronic pancreatitis (17%). There were no other conversions. There were three chemical leaks (25%) diagnosed by elevated drain amylase and low volume output, which were managed with intraoperatively placed drains removed at the initial postoperative clinic visit. There were three higher volume leaks (25%) that required extended or percutaneous drainage, with eventual removal. The average blood loss was 215 ml (range, 50–700 ml). The average operative time was 3 h and 41 min (range, 2 h 15 min to 5 h 58 min). The average length of hospital stay was 4 days (range, 2–7 days). Conclusion Splenic preservation should be performed when technically possible to decrease the morbidity of laparoscopic distal pancreatectomy. The choice to ligate the splenic vessels allows for shorter operative times with minimal perioperative morbidity and blood loss while maintaining the spleen.     

Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels for benign Pancreas neoplasm

Background Laparoscopic distal pancreatectomy to conserve the spleen is a beneficial operation for patients with benign and borderline malignancy in the pancreas. With this procedure, it is very desirable to preserve the splenic artery and vein as well. Methods From May 2000 to July 2003, five laparoscopic distal pancreatectomies with preservation of the spleen and splenic vessels were performed for benign pancreas neoplasm at Ewha Womans University Mokdong Hospital in Seoul, Korea. Results The postoperative pathologic diagnoses were two serous cystadenomas, two mucinous cystadenomas, and one solid and papillary epithelial tumor. The tumors ranged in size from 1.5 to 7cm. Four trocars (10–15 mm) and a laparoscopic linear stapler were used for transection of the pancreas. The mean operation time was 348 min, and the mean length of the incision for extraction was 3.6 cm. The mean postoperative hospital stay was 10.4 days. There was no complication or mortality. Conclusion Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels is a relatively safe and feasible option for the management of benign tumor or borderline malignancy in the distal pancreas. This study was supported by the Ewha Womans University Research Grant of 2004     

Laparoscopic distal pancreatectomy with preservation of the spleen

We describe a case of chronic pancreatitis treated by laparoscopic distal pancreatectomy with conservation of the spleen involving the resection of the splenic vessels. A proximal ligation of the splenic artery and vein was performed, followed by transection of the body of the pancreas. Retroperitoneum was dissected to the left by mobilizing the stump of the transected pancreas. The entire distal pancreas was freed posteriorly. The distal splenic artery and vein were ligated and divided individually adjacent to the tail of the pancreas at the hilum of the spleen. The points of this operation were to ligate the splenic artery and vein at both sides of the resected pancreas and to save the spleen with the blood supply continuing through the short gastric vessels and the splenocolic ligament. This operation with splenic preservation is more suitable for a patient who is a candidate for laparoscopic distal pancreatectomy, which will minimize the operation time, preserve the useful immunologic role of the spleen, and obtain the intact resected specimen. Furthermore, this procedure is useful in chronic pancreatitis patients because it avoids the difficult dissection of the posterior pancreas off of the splenic vessels.     

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。     

腹腔镜胰体尾（保脾）切除术

目的 探讨在腹腔镜下,对远端胰腺肿瘤患,施行胰体及胰尾部分切除手术的同时,保留脾脏的可能性。方法 在腹腔镜下,仔细分离胰体及胰尾部位与脾脏相关的血管,在原位保留与脾脏相连的胃短血管,为保留脾脏及完成胰腺体部及尾的切除创造条件。结果 本组11例中,除l例因胰腺癌灶的局部侵蚀,病变较重,无法分离脾门区血管,另l例因肥胖而被迫中转开腹手术外,其余9例均在腹腔镜下完成了胰腺的部分切除及保留脾脏的手术,随访平均30个月,情况良好。结论 位于胰腺体部或尾部的良性肿瘤患,有选择地在腹腔镜条件下进行胰腺体尾部的部分切除手术并保留脾脏是可行的。