腹腔镜远端胰腺切除的临床应用

Laparoscopic distal pancreatectomy for pancreatic tumors

目的总结腹腔镜远端胰腺切除术的临床应用与手术技巧。方法回顾性分析腹腔镜远端胰腺切除术治疗胰体尾肿瘤10例的临床资料。结果10例胰体尾肿瘤中8例成功完成腹腔镜远端胰腺切除术，其中1例为保脾远端胰腺切除术，中转开腹手术2例，1例因胰腺癌侵及周围脏器，1例因术中出血。腹腔镜远端胰腺切除术平均手术时间为141±35min（95～195min），平均出血263±151ml（100—600ml），术后平均住院7±1d（5～9d），全部患者均治愈。术后病理诊断实性假乳头状瘤4例、黏液性囊腺瘤3例、胰岛细胞瘤1例，胰腺导管腺癌2例。结论腹腔镜远端胰腺切除术最佳适应证是胰腺体尾部良性肿瘤及早期恶性肿瘤，具有创伤小、恢复快、并发症少的优点，是治疗胰体尾良性肿瘤及早期恶性肿瘤的安全有效的微创疗法。

Objective To summarize the clinical applications and surgical technique of laparoscopie distal pancreatectomy （LDP）. Method The clinical data of 10 cases of pancreatic body and tail tumors undergoing laparoseopic distal pancreatectomy were retrospectively analyzed. Results Laparoscopic distal pancreatectomy （LDP） was successfully undertaken in 8 cases （including spleen preserving distal pancreatectomy in one case）. Intraoperatively two cases were converted to open surgery because of peripancreatic organs involvement by cancer in one case and massive bleeding in another case during laparoseopic procedures. The average operation time of LDP was 141 ± 35 min （95 - 195 min） , mean blood loss was 263 ± 151 ml （100 -600 ml） , average postoperative hospital stay was 7± 1 days （5 - 9 days ）. There was no major postoperative complications and no mortality. Final pathology was solid psedopapillary tumor in 4 cases, mucinous cystadenoma in 3 cases and islet cell tumor in 1 case, pancreatic duetal adenocarcinoma in 2 cases, hence 80% of tumors were benign. Conclusions LDP is indicated for benign body and tail pancreatic tumors and early malignant tumor of pancreatic body and tail. Being less traumatic, and fewer complications, LDP is a safe, effective and minimally invasive therapy.