机器人腹腔镜保脾胰体尾良性肿瘤切除手术七例临床分析

Robotic-assisted iaparoscopic spleen-preserving distal pancreatectomy： a report of 7 patients

目的 胰体尾良性肿瘤切除手术需要尽量保脾.本研究旨在评估机器人保脾行胰体尾切除手术的安全性与可行性.方法 分析、总结解放军总医院2009年6月至2012年3月行机器人切除胰体尾良性肿瘤或交界性肿瘤7例病例资料.结果 7例患者均成功施行机器人胰体尾切除术,其中6例保脾,另1例因胰尾脾门粘连致密而行联合脾脏切除.6例保脾成功患者中,尚有1例行联合右肾上腺肿瘤切除术,1例胆囊切除术.无二次手术.平均手术时间368 min,出血200 ml.术后出血1例,给予止血药物后治愈,未再次手术.根据国际胰瘘研究小组定义,A级胰瘘1例.术后平均住院8.7d.无其他并发症发生.结论 机器人胰体尾切除手术安全可行.因其三维的视觉、稳定的操作,故在保脾方式上多采用Kimura法.该法能最大程度地保留脾脏完整的供血系统,减少术后区域性门脉高压发生的可能性.

Objective For benign or tumor of borderline malignancy in the distal pancreas,a spleen-preserving distal pancreatectomy can be carried out.This study aimed to assess the safety and feasibility of this operation.Methods Between June 2009 and March 2012,7 patients underwent laparoscopic distal pancreatectomy assisted by the da Vinci Robotic System （RDP） for benign or pancreatic tumor with borderline malignancy.The clinical data were analyzed.Results Robotic-assisted spleen-preserving laparoscopic distal pancreatectomy was successfully carried out in 6 patients,with robotic assisted splenectomy and distal pancreatectomy on the remaining patient.Among them,to the 6 patients with distal pancreatectomy,one patient received right adrenal tumor resection and another patient received cholecystectomy.The average operation time was 368 minutes,and the blood loss was 200 ml.One patient developed postoperative bleeding,and was treated conservatively with hemostatic drugs （grade Ⅱ）.There was no conversion to laparotomy.According to the international pancreatic fistula research team＇s classification of postoperative pancreatic fistula,1 patients were diagnosed to have pancreatic fistula （grade A）.The mean postoperative hospital stay was 8.7 days.There were no other complications.Conclusions Robotic-assisted spleen-preserving laparoscopic distal pancreatectomy was safe and feasible.The Kimura operation was used in spleen-preserving operations because its 3D visual field and stability in control helped to preserve splenic blood supply and reduced the chance of postoperative regional portal hypertension.