保留脾脏胰腺体尾切除术的临床应用研究

Clinical study of spleen preserving distal pancreatectomy

目的探讨保留脾脏胰腺远端切除术的手术适应证及临床意义。方法回顾性分析75例因胰腺体尾部占位病变而施行保留脾脏胰腺远端切除术病人的临床诊疗资料。结果本组75例均成功行保留脾脏胰腺体尾切除术，其中浆液性囊腺瘤18例、黏液性囊腺瘤15例，胰腺实性假乳头状瘤11例，慢性胰腺炎9例，导管内乳头状黏液性肿瘤8例（其中2例有恶变倾向），胰岛素瘤6例，胰腺假性囊肿4例，神经内分泌瘤3例和转移瘤1例。所有病人术后经B型超声证实脾脏血运完全正常，血小板均在参考值范围内。术后并发胰瘘9例（12％），均经保守治疗治愈。本组术后均未发生凶险性感染。术后随访期间，全部病人血糖都在参考值范围内，未发现肿瘤复发和转移迹象。结论保留脾脏胰腺体尾切除术是治疗胰腺体尾良性和交界性肿瘤最佳的术式，可减少脾切除术后凶险感染的发生，尤其是对儿童病人意义更大。

Objective To investigate the surgical indications and clinical significance of spleen preserving distal pancreatectomy. Metho@s The clinical data of 75 patients with the rna^s located in the body and tail of the pancreas underwent with spleen preserving distal panereateetomy were retro- spectively analyzed from Jan. 20[）5 to Jan. 2009, 75 in the center of pancreatic surgery, union hospi- tal, wuhan. Results All patients had been clone with spleen preserving distal panereateetomy success- fully. Among them, there were 18 serous cystadenoma, 15 mucinous cystadenoma , l 1 solid-pseudo- papillary tumor, 9 chronic pancreatitis, 8 intraductal papillary mucinous tumor （including two cases with malignant tendencies）,6 insulinoma ,4 pancreatic pseudocyst ,3 neuroendocrine tumor and 1 me- tastatic tumor. All patients had normal blood supply to the spleen （confirmed by the B ultrasound）, normal plate!ets and no postoperative hazardous infection, postoperatively. After operation, nine cases （12 %） occurred with pancreatic fistula and cured by conservative treatment. During postoperative follow-up period, all patients have normal blood sugar range, and no signs of tumor recurrence and metastasis. Conclusion Spleen preserving distal pancreatectomy is the best option for the surgical re- section of body and tail of benign and borderline pancreatic tumor, and could avoid the risks of hazard- ous infection after splenectomy, especially for children.