经小网膜入路的腹腔镜胰腺肿瘤剜除术的初步临床效果

The lesser omentum approach for laparoscopic pancreatic enucleation

目的 探讨经小网膜入路的腹腔镜胰腺肿瘤剜除手术的临床应用效果.方法 回顾性分析2011年6月至2013年10月解放军总医院肝胆外科采用经小网膜入路行腹腔镜胰腺肿瘤剜除的6例患者资料,男性1例,女性5例,平均年龄42岁,术前均诊断为胰岛素瘤.肿瘤位于胰颈部3例,胰颈体交界处2例,胰体部l例.肿瘤最大径0.8～2.5 cm.结果 6例患者手术均顺利完成,无中转开腹.术中手术时间为（82.5±19.4）min,出血量为（26.7±18.6）ml.术后发生A级胰瘘1例,余患者均未出现胰瘘及其他严重并发症.患者术后住院时间为（5.17±1.17）d.随访36～64个月,6例患者肿瘤均未复发,症状消失.结论 对于位于胰颈体部的胰岛素瘤,经小网膜入路简单直接,能安全快速地获得良好的手术视野及操作空间.

Objective To evaluate the feasibility and strategy of the lesser omentum approach for laparoscopic pancreatic enucleation.Methods Between June 2011 and October 2013,6 laparoscopic pancreatic enucleations were performed by lesser omentum approach.The average age was 42 years,including 1 male and 5 female.The preoperation diagnosis of 6 cases were pancreatic islet cell tumors determined by abdominal CT/MRI,ultrasound and digital subtraction angiography.The tumors of 3 cases located in pancreatic neck,2 tumors located in neck and body of pancreas,and 1 tumor located in pancreatic body.Their biggest tumor diameter were 0.8-2.5 cm.Results Among the 6 cases,all laparoscopic pancreatic enucleations were successfully performed.None of the patients were converted to open operation.Eestimated blood loss was （26.7 ± 18.6） ml,operating time was （82.5 ± 19.4） minutes,and postoperative length of stay was （5.17±1.17）days.Additionally,postoperative complication included grade A pancreatic fistula in 1 case.After 36-64 months followed-up,there was no tumor recurrence and clinical symptom disappeared.Conclusion For the islet cell tumors located in pancreatic neck and body,the lesser omentumapproach may contribute to good surgical view and operative space,which can make pancreatectomy safer and easier for clinical application.