3D腹腔镜在保脾胰体尾切除术中的应用价值

Application value of three-dimensional laparoscope in spleen-preserving distal pancreatectomy

目的探讨3D腹腔镜在保脾胰体尾切除术中的应用价值,并总结其临床应用经验和手术技巧。方法回顾性分析2014年1月至2016年5月在湖南省人民医院行3D腹腔镜保脾胰体尾切除术的16例胰体尾占位性病变患者临床资料。其中男5例,女11例;年龄23~64岁,中位年龄43岁。患者均签署知情同意书,符合医学伦理学规定。本组患者均采用Kimura法完成保脾胰体尾切除术。术中在胰腺后方分离并保留脾动、静脉,切除胰体尾部。观察患者的术中及术后情况,并对患者进行随访。结果本组所有患者均成功实施3D腹腔镜保脾胰体尾切除术。手术时间中位数为216(150~285)min,术中出血量273(150~500)ml,术中无中转开腹。术后发生胰瘘2例,1例经保守治疗治愈,1例并发出血,经再手术后治愈。术后无死亡病例,术后住院时间11(5~29)d。术后病理学检查示:浆液性囊腺瘤5例,黏液性囊腺瘤4例,潴留性囊肿3例,实性假性乳头状肿瘤2例,功能性胰岛细胞瘤2例。术后随访时间9(1~28)个月,患者生活质量良好,未见复发。结论 3D腹腔镜保脾胰体尾切除术治疗胰体尾部良性或交界性肿瘤有效、安全、可行,具有微创、术后并发症发生率低、术后恢复快等优点。

Objective To investigate the application value of three-dimensional （3D） laparoscope in spleen-preserving distal pancreatectomy, and summarize the clinical experience and surgical skills. Methods Clinical data of 16 patients with space-occupying lesions at the body and tail of pancreas who underwent 3D laparoscopic spleen-preserving distal pancreatectomy in Hunan Provincial People＇s Hospital from January 2014 to May 2016 were retrospectively analyzed. There were 5 males and 11 females with the age ranging from 23 to 64 years old and the median of 43 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients underwent spleen-preserving distal pancreatectomy using Kimura＇s procedure. During the operation, the splenic artery and vein were isolated and preserved behind the pancreas, and the body and tail of pancreas were resected. Intraoperative and postoperative conditions were observed and all patients were followed up. Results All patients underwent 3D laparoscopic spleen-preserving distal pancreatectomy successfully. The median operation time was 216 （150-285） min. The intraoperative blood loss was 273 （150-500） ml. No conversion to open surgery was observed during the surgery. Two cases of pancreatic fstula were observed after surgery, 1 case was cured by conservative therapy, and the other case was complicated with bleeding and was cured by reoperation. No death was observed after surgery. The postoperative length of hospital stay was 11 （5-29） d. Postoperative pathological examination indicated that 5 cases presented with serous cystadenoma, 4 with mucinous cystadenoma, 3 with retention cysts, 2 with solid pseudopapuillary tumors and 2 with functional islet cell tumors. The postoperative follow-up time was 9 （1-28） months, the patients had a good living quality and no recurrence was observed. Conclusions The 3D laparoscopic spleen-preserving distal pancreatectomy is an effcacious, safe and feasible procedure for distal pancreatic benign or borderline tumors. It has the advantages of minimal invasion, low incidence of postoperative complications and fast postoperative recovery.