腹腔镜胰体尾切除术28例分析

Laparoscopic distal pancreatectomy:analysis of 28 cases

目的探讨腹腔镜胰体尾切除术(laparoscopic distal pancreatectomy,LDP)的可行性及临床价值。方法回顾分析2014年5月至2016年9月28例施行LDP病人的临床资料。28例病人中,男性9例,女性19例,年龄17~69岁。结果 16例LDP联合脾脏切除,7例行Kimura法保脾LDP,5例行Warshaw法保脾LDP。术后病理:胰腺浆液性囊腺瘤2例,黏液性囊腺瘤9例,实性假乳头状瘤6例,导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)3例,胰岛素瘤3例,胰腺假性囊肿1例,慢性胰腺炎1例,胰腺癌3例。全组病人平均手术时间为(203±54)min;平均术中出血量为(115±138)ml。平均术后下床活动时间为(1.4±0.6)d;平均术后首次进食时间为(2.0±0.8)d;平均术后住院时间为(10±5)d。术后发生胰瘘9例(32.1%),其中A级胰瘘6例,未予特殊处理,自然痊愈;B级胰瘘3例,均经冲洗引流后痊愈。术后发生脾部分梗死2例,未予特殊处理,经3个月随访观察自然痊愈。结论 LDP安全可行,具有微创优势,值得推广应用。

Objective To evaluate the feasibility and clinical applied value of laparoscopie distal pancreatectomy （LDP）. Methods The clinical data of 28 patients undergoing LDP from May 2014 to September 2016 in our hospital were retrospectively analyzed. Among the 28 patients,9 were male and 19 were female,with the age ranging from 17 to 69 years old. Results LDP with splenectomy was per- formed on 16 cases, and laparoscopic spleen-preserving distal pancreatectomy with Kimura＇s procedure or Warshaw＇s method was performed on 7 cases and 5 cases respectively. Pathologic examination showed serous cystadenoma in 2 patients, mucous cystadenoma in 9 patients, solid pseudo-papillary tumor in 6 patients, intraduetal papillary mucinous neoplasm（IPMN） in 3 patients, insulinoma in 3 pa- tients, pseudo cyst in 1 patient, chronic pancreatitis in 1 patient and pancreatic ductal adenocarcinoma in 3 patients. The average operation time was （203 ± 54） rnin,mean blood loss was （115 ± 138） mL, and the mean postoperative stay was （10 ± 5） days. There were 9 cases of pancreatic fistula （32. 1%） with clinical pancreatic fistula of 3 cases which were cured by irrigation and drainage. Spleen infarction oc- curred in 2 cases following Warshaw procedure, and cured by conservative treatment. Conclusions LDP is safe, feasible and effective with minimally invasive advantage, and it is worth of wide applica- tion.