改良腹腔镜胰体尾切除术12例报告

目的:探讨腹腔镜胰体尾切除术(laparoscopic distal pancreatectomy,LDP)中应用Endo-GIA一并闭合、离断胰腺及脾血管的安全性、可行性。方法:2010年3月至2011年11月共为12例患者行LDP,术中应用Endo-GIA一并闭合、离断胰腺及脾血管。术前8例诊断囊腺瘤,不排除恶变可能;4例胰尾部局限性癌变。结果:11例成功完成腹腔镜手术,1例中转开腹。手术时间115～210 min,平均153 min;术中出血量50～400 ml,平均187 ml;术后住院6～20天,平均9.6天。术后均未发生脾血管出血,2例发生胰漏,经充分引流后痊愈。结论:应用Endo-GIA一并闭合、离断胰腺及脾血管安全、可靠,LDP是治疗胰体尾低度恶性肿瘤及局限性癌变的可行术式。

The clinical observations of the modified laparoscopic distal pancreatectomy in 12 cases

Objective:To explore the safety and feasibility of the improved laparoscopic distal pancreatectomy(LDP) with Endo-GIA cutting off pancreas and splenic vessels.Methods:Between Mar.2010 and Nov.2011,12 cases were treated by LDP using Endo-GIA to cut off both pancreas and splenic vessels.Before the operation,8 cases were diagnosed with cystadenoma and suspected malignant neoplasm.4 cases were diagnosed with malignant lesions localized at the pancreatic tail.Results:Eleven of the operations were completed successfully by LDP,1 was converted to open distal pancreatectomy.The average operation time was 153(range 115-210) min,and the average blood loss was 187(range 50-400) ml.The patients were discharged in 6 to 20 days after operation(median,9.6 days).None of the patients developed splenic vascular hemorrhage.2 of the patients developed pancreatic leakage and was cured by percutaneous drainage.Conclusions:LDP using Endo-GIA to cut off both pancreas and splenic vessels is safe and feasible for low grade malignant neoplasm and malignant lesions localized at the body or tail of the pancreas.