腹腔镜胰体尾切除术的应用体会及技术改进

Analysis of laparoscopic distal pancreatectomy with 14 cases

目的探讨腹腔镜胰体尾切除术的安全性、疗效和手术操作技巧。方法回顾性分析我院从2013年2月到2014年5月行腹腔镜胰体尾切除术的14例临床病例资料,对腹腔镜胰体尾切除术的安全性、近期疗效和手术操作要点分析总结。结果 14例均顺利完成腹腔镜手术,其中7例行保留脾脏的胰体尾切除术,7例联合脾脏切除,无手术中转,平均手术时间(172.25±39.41)min,平均术中出血(185.0±135.25)ml,平均术后禁食时间为(3.6±1.2)d,术后疼痛指数均在3分以下,平均术后住院时间(6.81±4.62)d。术后2例出现胰瘘(14.3%),其中1例合并腹腔内出血,再手术治愈,1例延迟拔管痊愈,无死亡病例,术后病理中,6例为粘液性囊腺瘤,5例胰腺神经内分泌肿瘤(其中2例为胰岛素瘤),1例实性假乳头状肿瘤和2例胰腺癌。结论腹腔镜胰体尾切除术在临床应用中是安全可行的,具有微创和快速康复的优势,起初开展该技术需选择合适的病例,且需要建立固定的腔镜操作团队,方能获得满意的疗效。

Objective To sum up the efficacy and experience of laparoscopic distal pancreatectomy. Methods a retrospective analysis about, totally 14 patients include male 5 and female 9, aged 17 - 68 years, who with distal pancreatic lesions, the date from February 2013 to May 2014. Safety,feasibility and crucial technique manipulation were analyzed retrospectively. Results All of 14 operations were successful, include 7 cases with preservation of spleen, others with splenectomy. The average time of operation was （ 172.25 ± 39.41 ） minutes, the average intraoperative blood lose was（ 185.0± 135.25 ） ml, the first time that eating liquid after operation was （3. 6 ± 1.2） day, and the mean postoperative hospital stay was （ 6. 81 ± 4. 62 ） day. the rate of clinical pancreatic fistula was 14.3% （2/14）. one patients who with clinical pancreatic fistula merge the abdominal cavity infection and an other one combined abdominal bleeding. All of them after conservative treatment were cured, no reoperation and death patients. Conclusion laparoscopic distal pancreatectomy with or without splenectomy is safe and feasible in the treatment of most distal pancreatic tumors.