腹腔镜手术在胰腺疾病中的临床应用探讨

Clinical Application of Laparoscopy in Treatment of Pancreatic Diseases (Report of 12 Cases)

目的探讨腹腔镜手术在胰腺疾病中的临床应用效果。方法对12例胰腺疾病患者施行腹腔镜手术,其中包括胰腺囊性疾病9例,分别行保留脾脏的胰体尾切除术(4例)、胰体尾加脾脏切除术(2例)及单纯胰腺囊肿切除术(3例);胰岛素瘤2例,均行胰岛素瘤切除术;胰腺癌术后复发1例,行左侧内脏神经离断术。结果所有手术均获成功,其中完全腹腔镜下手术8例,经腹腔镜辅助手术4例。平均手术时间225min(100～420min),平均出血量80ml(2～150ml);1例术后发生胰瘘,经保守治疗治愈;术后平均住院时间7.2d(5～13d)。胰腺癌术后复发患者术后存活6个月,止痛效果满意;其余患者随访10～36个月,效果良好,无复发。结论腹腔镜手术治疗部分胰腺疾病安全有效,具有创伤小、痛苦轻、恢复快、并发症少等优点,具有广阔的应用前景。

Objective To explore the clinical value of laparoscopy in the treatment of pancreatic diseases. Methods Twelve patients with pancreatic diseases received laparoscopic surgery. Among which 9 patients with cystic diseases, 4 cases underwent laparoscopic spleen-preserving distal pancreatectomy, 2 cases received distal pancreatectomy and splenectomy, and 3 cases underwent pancreatic cystectomy. Laparoscopic insulinoma enucleation was performed for 2 patients who suffered from insulinoma. Besides, a patient suffered from pancreatic carcinoma recurrence received left thoracoscopic splanchnicectomy. Results All the operations were accomplished successfully, including 8 total laparoscopic surgery and 4 laparoscopic assisted surgery. The average operative time was 225 rain （range 100-420 rain）, and the average volume of blood loss was 80 ml （range 2-150 ml）. Pancreatic fistula was observed in 1 patient which was cured by conservative therapy. The postoperative average hospital stay was 7.2 d （range 5-13 d）. The patient with recurrent pancreatic carcinoma survived for 6 months after operation and the pain-killing effect was satisfactory. With a follow-up of 10--36 months for other patients, the surgical effects were ideal and no recurrence occurred. Conclusion With the advantages of less trauma, less pain, fast recovery, and low morbidity rate, laparoscopic surgery is an effective and safe method for the treatment of pancreatic diseases, and thus may be widely used in the clinical settings in the future.