腹腔镜胰腺远端切除术临床应用

The clinical applications of laparoscopic distal pancreatectomy

目的探讨腹腔镜胰腺远端切除术的安全性及可行性。方法 2005年9月至2009年6月,对36例胰腺体尾部肿物行腹腔镜胰腺远端切除术。术前34例诊断为胰腺体尾部良性肿物,2例不除外恶性,肿物中位直径5cm,平均(1.2～12)cm。结果所有手术均在全腹腔镜下完成。21例行保留脾脏的胰体尾切除(15例保留脾动静脉,6例未保留脾动静脉),14例行胰体尾加脾切除,1例既往行胰体尾及脾切除者行胰体部切除。手术中位时间248min,平均(118～400)min,中位出血量100ml,平均(50～800)ml,术后中位住院时间9d,平均(6～21)d。无胰漏或脾梗死发生,2例包裹性积液,均保守治疗治愈,1例引流管口感染。所有患者得到随访,中位随访时间25.5个月,平均(1～46)个月,均无复发。结论胰腺体尾部肿物行腹腔镜胰腺远端切除术安全、可行。

Objective To evaluate the safety, feasibility of laparoscopic distal pancreatectomy（LDP）.Methods The medical records of all 36 patients undergoing laparoscopic resection of distal pancreas with diagnosis of masses located at pancreatic body/tail from September 2005 to June 2009 were reviewed.Preoperative diagnoses were： 34 with benign masses and 2 with suspected malignant neoplasm.The median size of the tumors was 5 cm （range, 1.2-12） cm.Results ALL of the laparoscopic operations were performed successfully.21 patients were treated with laparoscopic distal pancreatectomy with preservation of the spleen, consisting of 15 with splenic vessels preservation and 6 without splenic vessels preservation.14 patients with laparoscopic distal splenopancreatectomy and the other one with resection of pancreatic body only who had open distal splenopancreatectomy before.The median operative time was 248 minutes （range,129-400） minutes, with intraoperative blood loss of 100 ml （range,50-800 ml） and postoperative hospital stay of 9 days （range,6-21） days.No pancreatic fistula or splenic infarction occurred.The follow-up was performed in each patient with the median time of 25.5 months （range,1-46）months.During the follow-up, no recurrence was detected.Conclusions Laparoscopic distal pancreatectomy is safe and feasible for benign tumors located at the body or tail of the pancreas.