脾结肠韧带入路的腹腔镜或机器人胰尾肿瘤切除术

Splenocolic ligament approach for laparoscopic or robotic distal pancreatectomy

目的:探讨脾结肠韧带入路的腹腔镜或机器人胰尾肿瘤切除术的临床应用及选择策略。方法:回顾分析2007年9月至2016年9月为22例胰尾良性或交界性占位病变患者经脾结肠韧带入路行腹腔镜与机器人胰尾肿瘤剜除或胰尾切除术的临床资料。结果:22例手术均顺利完成,腹腔镜手术12例,机器人手术10例(1例为单孔机器人胰岛素瘤剜除术),无一例中转幵腹。剜除术13例(59.09%),Kimura术7例(3L82%),胰尾联合脾脏切除术2例(9.09%)。术中出血量平均(77.0±87.67)ml,手术时间平均(122.47±24.02)min,术后平均住院(6.65±2.02)d。术后并发A级胰瘘2例(9.09%),未出现B级或以上胰瘘。结论:脾结肠韧带入路安全、可行,能有效降低微创胰尾手术的技术难度。对于有丰富腹腔镜与机器人胰腺切除手术经验的团队,胰尾的良性或交界恶性肿瘤的微创手术入路可优先选择脾结肠韧带入路。

Objective：To evaluate the feasibility and strategy of splenocolic ligament approach for distal pancreatectomy.Methods：Between Sep.2007 and Sep.2016,twenty-two patients with benign and borderline neoplasms in the tail of pancreas underwent laparoscopic or robotic enucleation or distal pancreatectomy by splenocolic ligament approach.Results：Among the 22 cases,laparoscopic or robotic procedure were successfully performed in 12 and 10 cases（including one case of single-port robotic enucleation of insulinoma）,respectively.None of the patients required conversion to an open operation.Enucleation,spleen-preserving distal pancreatectomy（Kimura procedure） and distal pancreatectomy with splenectomy were performed in 13（59.09%）,7（31.82%） and 2（9.09%） patients,respectively.The mean estimated blood loss was（77.0±87.67） ml,the mean operating time was（122.47±24.02） min,and the mean postoperative hospital stay was（6.65±2.02） d.Additionally,postoperative complications included 2（9.09%） cases of grade A pancreatic fistula.Conclusions：Splenocolic ligament approach may contribute to safer and easier distal pancreatectomy in laparoscopic or robotic surgery.In our experience,splenocolic ligament approach can be safely adopted and is a feasible approach for minimal invasive distal pancreatectomy.