腹腔镜胰腺远端切除术治疗体会

Laparoscopic distal pancreatectomy: current indications and surgical results

目的探讨腹腔镜下胰腺远端切除术的手术适应证、安全性和可行性。方法选择2005年2月-10月住院的连续10例胰体尾占位患者,年龄(43．4±14．7)岁,男1例,女9例。9例术前诊断为囊性占位,肿瘤最大径平均4．0 cm(2．6～8．5cm);1例术前诊断为胰体尾病变伴肝转移,胰腺内分泌肿瘤可能性大。其中7例行保留脾脏胰腺远端切除术,3例行胰腺远端+脾切除术。结果10例手术均完全在腹腔镜下完成。手术时间(228±26)min,术中出血量(173±100)ml。术后胰瘘1例(10％),充分引流1个月后自行愈合;1例患者术后1个月复查发现胰腺断端旁有假性囊肿形成,直径约2 cm,观察1个月后囊肿消失。其余8例无并发症发生。术后平均住院13．5 d(12～16 d)。10例患者术后血糖均正常。10例随访2～22个月(中位数8个月),9例囊性病变患者均无复发,1例内分泌癌随访1年,肝脏转移病灶无明显变化,原发部位无肿瘤复发。结论对于病变位于胰体尾的良性肿瘤或疾病,选择腹腔镜胰腺远端切除术是安全、可行的。

Objective To evaluate the safety, feasibility indications, prognosis and follow-up of laparoscopic distal pancreatectomy. Methods Retrospective study was employed on 10 patients collected from Feb. to Oct. 2005 with diagnosis of masses located at pancreatic body/tail. The mean age was 43 years and ratio between male and female was 1：9. Preoperative diagnosis： nine patients with cystic lesion located at pancreatic body and tail, one patient with pancreatic endocrine tumor with liver matastasis, which located at pancreatic tail. The mean size of the tumor was 4.0 cm. All patients received adjuvant examinations including CT contrast scan, abdominal ultrasound or endoscopic ultrasound. The serum levels of tumor markers （including CA19-9, CA242, CA50 and CEA） of the patients were all normal. Results All patients received distal pancreatectomy by laparoscope successfully. Among them, seven procedures were spleen-preserved and three with splenectomy. Mean operative time was 228 ± 26 min, and mean blood lose volume was 173 ± 100 ml. One patient suffered with pancreatic fistula after operation but was successfully managed by conservative therapy in one month, pancreatic pseudocyst was detected in one patient and disappeared spontaneously in one month, no other morbidity occurred. The postoperative hospital stay was 12 - 16 d （ mean, 13.5 d）. The serum glucoses of 10 patients after operation were normal. The mean time of follow-up was 8 months （2 - 22 months）. During the follow-up, nine patients with benign cystic lesions did not relapse. And the other one patient with malignant metastasis kept stable, not recurrence was detected in one year after operation. Conclusions Laparoscopic distal pancreatectomy was safe and feasible for benign cystic tumors located at the body or tail of the pancreas.