保留脾和脾动、静脉胰体尾切除术（附五例报告）

Distal pancreatectomy with spleen and the splenic vessels preservation：a report of 5 cases

目的探讨保留脾和脾动、静脉的胰体尾切除术的手术适应证与安全性。方法回顾性分析我院1997年11月至2008年3月行保留脾和脾动、静脉的胰体尾切除术的5例临床资料。胰腺囊腺瘤2例，胰腺囊腺癌1例，胰腺实性假乳头状瘤1例，胰腺外伤1例，采取先暴露脾动脉，切断胰腺，近心端胰断面间断缝合，提起胰腺远断端，于脾静脉鞘内分离结扎切断其与胰体尾间的分支，结果5例安全地实施保留脾和脾动、静脉的胰体尾切除术，术后无一例胰瘘发生。结论保留脾和脾动、静脉的胰体尾切除术难度较大，但对于胰体尾良性、交界性肿瘤和未侵犯脾血管的恶性肿瘤是较好的选择。

Objective To explore the operative indication and safety of distal pancreatectomy with spleen and the splenic vessels preservation. Methods The clinical data of 5 cases of distal pancreatectomy with preservation of the spleen and splenic vessels from November 1997 to March 2008 in our hospital were analyzed retrospectively. Among them, there are 2 cases of pancreatic cystadenomas, 1 case of cystadenocarcinoma, 1 case of solid pseudopapillary epithelioma, 1 case of pancreatic injury. The splenic artery was exposed first in operation, then cut off the pancreatic body with interrupted suture of the proximal pancreatic cross - section. After raising the distal pancreatic body, the branches between splenic vein and the body and tail of pancreas were disassociated and ligated in vaginae vasorum of splenic vein. Results This operation could be completed in safety with these procedures described above. No post - operative pancreatic fistula occurred in all cases. Conclusion It is difficult to do the opration of distal pancreatectomy with spleen and splenic vessels preservation, but it would become the best choice for the treatment of benine and borderline tumors and carcinomas without spenic vessels invasion.