腹腔镜胰腺假性囊肿内引流及胰腺远端切除的初步体会

PRELIMINARY EXPERIENCE FOR LAPAROSCOPIC TRANSGASTRIC DRAINAGE OF PANCREATIC PSEUDOCYST AND DISTAL PANCREATECTOMY

目的探讨腹腔镜下胰腺假性囊肿-胃内引流术和保留脾脏胰腺远端切除术(Kimura法)的可行性和安全性。方法总结完全腹腔镜下1例胰腺假性囊肿-胃内引流术和4例保留脾脏胰腺远端切除术(Kimura法)的治疗体会。结果胰腺假性囊肿-胃内引流手术时间150 min,出血量150 ml。术后胰腺假性囊肿明显缩小,脾静脉受压明显缓解。4例胰腺远端切除平均手术时间245 min,平均出血量180 ml,平均住院时间7.8 d。1例胰腺远端切除患者术后1个月复查时发现胰腺断端旁有假性囊肿形成,直径约3 cm,观察6个月后囊肿无变化。5例患者中位随访时间8.2月,胰腺假性囊肿及肿瘤均无复发。结论腹腔镜下胰腺假性囊肿-胃内引流术和保留脾脏胰腺远端切除术(Kimura法)是安全可行的,具有创伤小、术后恢复快等优点,但适应症的选择至关重要。

Objective To evaluate the feasibility and safety of laparoscopic transgastric pancreatic pseudocyst drainage and distal pancreatectomy with preservation of spleen.Methods From Jan to Dec 2008,4 patients underwent laparoscopic distal pancreatectomy with spleen-preserved and 1 patient with pancreatic pseudocyst received laparoscopic transgastric drainage.The therapeutic experience was summarized.Results The operative time of transgastric pancreatic pseudocyst drainage was 150 min and the blood loss was 150 ml.The pancreatic pseudocyst disappeared after operation.The mean operative time of 4 patients for distal pancreatectomy was 245 min and the mean blood loss volume was 180 ml.The mean postoperative hospital stay was 7.8 d.1 patient suffered with pancreatic pseudocyst with 3 centimeter after postoperative 1 month and no change has been found till now,no other morbidity occurred.The mean time of follow-up was 8.2 months.During the follow-up,no recurrence was detected in these 5 patientsConclusions Laparoscopic distal pancreatectomy with preservation of spleen and transgastric drainage of pancreatic pseudocyst are safe and feasible with the advantage of less injury and earlier recovery.It is critical to choose proper indications.