腹腔镜胰体尾切除术68例单中心经验

Laparoscopic distal pancreatectomy ： the experience of 68 cases in a single centre

目的总结腹腔镜胰体尾切除术（LDP）的临床应用经验。方法回顾性分析2003年11月至2010年12月行LDP的68例患者临床资料。其中男性23例，女性45例；年龄17～77岁，中位年龄47岁。对LDP的安全性、可行性及手术技术操作进行总结分析。结果患者中除2例中转开腹外，余66例在腹腔镜下顺利完成手术。其中48例LDP联合脾脏切除术中10例合并多脏器切除，18例保留脾脏LDP中4例合并多脏器切除。平均手术时间（209±58）min，平均术中出血量（191±123）ml，平均术后下床活动时间（1．2±0．6）d，首次进食流质时间（2．8±1．1）d，术后住院时间（8±4）d。术后发生胰漏8例（12．1％）；4例延长拔管时间、充分引流，抗感染治疗后痊愈，3例行CT引导下腹腔积液穿刺引流后痊愈（1例同时合并睥梗死），1例因胰漏致腹腔感染行二次手术后痊愈。其余术后并发症包括腹腔感染1例，肺部感染2例，乳糜漏1例，总体并发症发生率为18．1％；无围手术期死亡。术后病理结果显示肿块大小1．5～15．0cm，平均（6±3）cm；切除胰腺长度6．5～10．0cm，平均（7±2）cm。病理类型包括胰腺良性病变29例，交界性或低度恶性病变27例，恶性病变12例。结论对于具有丰富腹腔镜手术及开腹胰体尾手术经验的术者，LDP治疗胰腺体尾部占位性病变安全可行.

Objective To evaluate the feasibility and efficacy of laparoscopic distal pancreatectomy. Methods Totally 68 patients （male 23, female 45） aged 17 to 77 years, with distal pancreatic lesions, underwent laparoscopic distal pancreatectomy fi＇om November 2003 to December 2010. The clinical data were collected. Safety, feasibility and crucial technique manipulation were analyzed retrospectively. Results All 68 operations were successful with two cases conversion to open, including 48 casescombined with splenectomy, and 18 cases with preservation of spleen. Fourteen cases received with combination resection of muhi-organs, including 4 cases with eholecystectomy, 1 case resection of right adrenal adenoma and cholecysteetomy, 1 case with myomectomy and left ovarian teratomeetomy; 1 case with right ovarian teratomectomy, 1 case with resection of left adrenal adenoma, 1 case with resection of both adrenal adcnoma, 1 case with resection of liver metastasis, 1 case with cholecystectomy and resection of liver metastasis, 1 case with resection of left adrenal adenoma and liver metastasis, 1 case with resection of left adrenal adenoma and colon and spleen, 1 case with biopsy of liver nodule. The mean operative time was （209±58） minutes, the mean intraoperative blood loss was （191±123） ml, and the mean postoperative hospital stay was （ 8 ± 4） days. The rate of overall postoperative complications was 18. 1% , including an 12. 1% rate of clinical pancreatic fistula. Only one case needed a reoperation, and there was no postoperative mortality. Conclusion Laparoscopic distal pancreatectomy with or without splenectomy is safe anti feasible in the treatment of most distal pancreatic tumors.