胰腺局部精准切除术治疗胰腺良性肿瘤的临床体会

Clinical efficacy for precise pancreatectomy for benign lesion

目的:评价胰腺局部精准切除术(尽可能保留有功能的胰腺组织)的临床可行性、安全性和疗效。方法:分析2007年1月以来本科开展的17例次胰腺局部精准切除术的临床资料。结果:保脾胰体尾切除术11例,中段胰腺切除术5例,保留十二指肠的胰头切除术1例,术后均康复出院。平均手术时间(3.0±0.78)h,术中平均出血量(258.8±86.65)ml,全组病例术中均未输血。保脾组中2例快速病理示恶性肿瘤后即刻加行脾切除术,1例术后胰尾小囊肿;中段胰组中1例术后脾静脉迟发性破裂出血再手术切除脾脏;保留十二指肠胰头切除病例术后短期小流量胰瘘。全组术后血小板计数为(273.1±43.76)×109L-1,术后平均住院时间为(15.8±7.07)d,术后随访4～48个月,病理提示良性肿瘤者均未见复发及转移。结论:胰腺局部精确切除术治疗胰腺良性肿瘤疗效确切,并可达到最小创伤、最大脏器保有和最佳康复的效果。

Objective： To investigate the feasibility, safety, effect of spleen-preserving precise pancreatectomy, and to discuss its indications and techniques. Methods： The clinical data of seventeen patients undergoing precise pancreatectomy with spleen preserved between Jan 2007 and December 2010 were analyzed retrospectively. Results： Out of the seventeen cases, eleven cases received distal pancreatectomy, while other five cases received the middle pancreatectomy, only one case received duodenum-preserving pancreatectomy. Frozen section examination of the pancreatic stumps, however, revealed malignant changes in two cases of the distal pancreatectomy patients, and splenectomy was then performed. The operation time was （ 3.0 ± 0.78 ） h and the intraoperative blood loss was （258.8 ± 86.65 ） ml. Only one case suffered from pancreatic fistula, who finally recovered after medicine therapy and percutaneous drainage; one case suffered from delayed bleeding of splenic vein, who then recovered after splenectomy; one case of small pancreatic cyst finally recovered after medicine therapy. There was no other complication or operative mortality. The postoperative platelet count was （273. 1 ± 43.76） x 10^9 -L-1 and the postoperative hospital stay was（ 15.8 ± 7.07） d. For seventeen cases of patients, no recurrence and metastasis was found after the follow up （ 16.2 ±8. 14 ） months （ 4- 48 months ）. Conclusion ： Precise pancreatectomy with spleen preserved is a safe and feasible procedure, which is worthy for selected cases such as benign neoplasm of the body, tail and even the head of the pancreas, resulting minimal invasion, maximal tissue reserve and optimal rehabilitation.