摘要
目的总结腹腔镜胰体尾切除术在肝胆外科中的临床应用经验。方法回顾性分析解放军总医院25例腹腔镜胰体尾切除术患者的临床资料，其中9例患者行腹腔镜胰体尾联合脾脏切除术，16例患者行腹腔镜保留脾脏的胰体尾切除术，将同期我院行开腹胰体尾切除的42例患者临床资料作为对照组进行比较。结果腹腔镜组患者在术后胃肠功能恢复、切口长度、住院时间、并发症发生率等方面要明显优于开腹组[腹腔镜组患者平均拔除胃管时间（1．5±0．9）h，平均术中出血量（256±188）ml，平均切口长度（4．6±0．9）cm，术后住院时问（7．1±1．9）d；开腹组拔除胃管时间（2．7±0．7）h，平均术中出血量（305±288）ml，平均切口长度（20．1±4．2）cm，术后住院时间（11．2±3．2）d]差异具有统计学意义（P〈0．05）。腹腔镜组4例患者术后发生胰瘘（A级3例、B级1例），均经保守治疗后治愈，无临床死亡患者。结论腹腔镜胰体尾切除术是安全可行的，值得在临床进一步推广。
Objective To explore the clinical application of laparoscopic distal pancreatectomy （LDP） in hepatobiliary operations. Methods The clinical data of LDP from 25 cases from June 2008 to December 2011 were retrospectively analyzed. Among them, 9 patients underwent LDP with excision of spleen while another 16 patients had LDP with preservation of spleen. And during the same period, 42 patients undergoing open distal pancreatectomy were selected into the control group. And the patient data of two groups were compared. Results All of them underwent successfully LDP. Among 16 patients with preservation of spleen, 11 patients undergone the Kimura procedure while another 5 undergone the Warshaw operation. The operative duration was （4. 5 ±1.2） hours, volume of blood loss （256 ±188） ml, length of incision （4. 6 ±0. 9） cm, mean time of oral food taking （ 1.5 ±0. 9） days and mean postoperative hospital stay （7.1 ±1.9 ） days. Pathological examinations showed benign tumor （ n = 20）, malignant tumor （ n = 4） and borderline tumor （n = 1 ）. The mean data of LDP group was significantly less than that of open distal pancreatectomy group in terms of anal exsufflation time, length of incision, postoperative hospital stay time and complication rate, etc. （P 〈 0. 05 ）. Four patients were diagnosed of post-LDP pancreatic fistula （ 3 A level vs 1 B level） and all of them became cured after conservative treatment. There was no mortality. Conclusion As a safe and feasible procedure, LDP is worthy of wider applications.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第44期3128-3130,共3页
National Medical Journal of China
