两种保留脾脏胰体尾切除术在胰体尾部良性病变中的应用比较

A comparative analysis on two procedures of spleen-preserving distal pancreatectomy for benign pancreatic lesions

目的:对保留脾血管的保留脾脏胰体尾切除术(SPDP)及合并脾血管切除SPDP术临床疗效进行比较。方法:回顾性分析2002年1月至2010年6月45例行SPDP术患者的临床资料,其中保留脾血管的SPDP24例(观察组),合并脾血管切除SPDP21例(对照组)。比较两组手术时间、术中出血量、术后并发症、术后住院时间的差异。结果:两组患者一般资料差异无统计学意义。观察组和对照组手术时间分别为(258.5±27.3)min和(169.9±31.4)min(P<0.01),术中出血量分别为(161.4±30.0)mL和(292.3±54.9)mL(P<0.01),术后血小板计数分别为(213.4±48.9)×109/L和(306.3±58.9)×109/L(P<0.01),术后住院时间分别为(13.0±2.7)d和(20.0±4.7)d(P<0.01)。观察组术后并发症明显少于对照组(P<0.05),两组胰瘘发生率差异无统计学意义(P>0.05)。结论:与合并脾血管切除SPDP相比,保留脾血管SPDP尽管手术难度大,但因避免损伤脾血管,保护了脾脏的正常结构及功能,并发症少,应为SPDP手术的首选术式。

Objective To compare the clincial efficacy of two procedures of spleen-preserving distal pancreatectomy （SPDP）. Methods The clinical data on 45 patients who had received SPDP with splenic vessel persevation （24 patients, study group） or with splenic vessel removal （21 patients, control group） from January 2002 to June 2010 were retrospectively analyzed. The surgical duration, mean volume of introperative bleeding, postoperstive complication, length of postoperative hospital stay were compared between the two groups. Results The clinical data did not differ singnificantly between the two groups. The surgical duration was （258.5 ±27.3） min in the study group and （ 169.9± 1.4）min in the control group （P 〈 0.01 ）, mean volume of introperative bleeding was （161.4 ± 30.0）mL in the control group and （292.3± 54.9）mL in the study group （P 〈 0.01）, and mean platelet count was （213.4 ± 48.9）×10^9/L and （306.3 ± 58.9） × 10^9/L （P 〈 0.01）. Postoperstive complications were fewer in the study group than in the control group （P 〈 0.05）. There was a difference in mean postoperative length of hospital stay between the two groups [（13.0±2.7）d vs. （20.0± 4.7）d, P 〈 0.01]. The incidence of pancreatic fistula did not differ singnificantly （P 〉 0.05）. Conclusions As compared with SPDP with splenic vessel removal, SPDP with vessel persevation is a first-choice procedure for benign pancreatic lesions due to avoidance of injury to spenlie artery and to normal function and structure of the spleen and due to fewer complications.