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。

The experience of 32 cases of laparoscopic distal pancreatectomy

ObjectiveTo summarize the experience of laparoscopic pancreaticotailectomy, and investigate the feasibility and clinical value of the therapy for pancreatic tail-mass. MethodsClinical data of 32 patients who underwent pancreaticotailectomy in the Department Liver and Gallbladder Surgery of Cangzhou People′s Hospital from Jan. 2016 to Dec. 2019 were retrospectively analyzed.Among them, there were 12 males and 20 females, aged 13-75 years, and the average age was (41.3±3.7)years. During the operation, whether to retain the spleen or not was determined according to the features of the tumor, the relationship between the tumor and splenic vessels, and the degree of spleen injury. ResultsExcept for one patient who underwent laparotomy due to tumor invasion of transverse colon, the other 31 patients underwent laparoscopic resection.Spleen was retained in 12 cases (8 by Kimura method and 4 by Warshaw method) and 20 by combined splenectomy.The mean operation time was (252±75) min, and the mean intraoperative blood loss was (162±51) ml.Postoperative hospital stay was (11.6±3.2) days.Postoperative pathology: solid pseudopapilloma (10 cases), serous cystadenoma (6 cases), mucinous cystadenoma (4 cases), neuroendocrine tumor (4 cases), pancreatic adenocarcinoma (3 cases), inductal papillary myxoma (3 cases), pancreatic pseudocyst (1 case), and pancreatic tail injury (1 case). Postoperative pancreatic leakage occurred in 10 cases, and they were cured and discharged after adequate drainage and anti-infection treatment.There were 1 case of chylous leakage, 1 case of peritoneal hemorrhage (recovered after conservative treatment with somatostatin and hemostatic agents), and 5 cases of new postoperative diabetes. ConclusionsLaparoscopic pancreaticotailectomy is safe and effective in the treatment of pancreatic body and tail tumor. Surgeons with extensive experience in laparoscopic surgery can perform them.