Kimura法腹腔镜胰体尾切除术中脾血管分离技巧探讨

Clinical experience in separation of splenic vessels during laparoscopic distal pancreatectomy with Kimura's procedure

目的:探讨Kimura法(腹腔镜下保留脾血管的胰体尾切除术)中脾血管分离的技术要点。方法:回顾性分析2015年1月—2016年12月采用Kimura法实施的18例胰腺体尾部切除患者的临床资料。结果:18例均顺利完成Kimura手术,手术时间136~220 min,平均170 min,出血量50~450 mL,平均180 mL,术后平均住院时间6~21 d,平均9.6 d,术后病理均为胰腺良性或交界性肿瘤。10例患者术中使用5-0的Prolene线缝合脾静脉或脾动脉裂口。术后主要并发症为腹腔胰瘘,其中A级胰瘘8例(44.4%),B级胰瘘2例(11.1%),均经保守治疗治愈。结论:Kimura法治疗胰体尾部良性及交界性肿瘤是安全可行的,完善的术前准备、娴熟的腔镜下操作技术和配合能力,尤其是掌握脾血管分离和缝合技巧是完成手术的关键。

Objective： To investigate the technical essentials of separation of the splenic vessels in performing Kimura’s procedure （laparoscopic resection of the body and tail of the pancreas with splenic vessel preservation）. Methods： The clinical data of 18 patients undergoing resection of the pancreatic body and tail using Kimura’s procedure from January 2015 to December 2016 were retrospectively analyzed. Results： Kimura’s procedure was successfully completed in all the 18 patients. The operative time ranged from 136 to 220 min, with an average of 170 min, and the intraoperative blood loss ranged from 50 to 450 mL, with an average of 180 mL, and the length of hospital stay ranged from 6 to 21 d. with an average of 9.6 d. Postoperative pathology showed that all the lesions were benign or borderline tumors of the pancreas. Ten patints underwent splenic vein or artery repair for lacerations with a 5-0 Prolene suture during operation. Abdominal pancreatic fistula was the main complication, which occurred, including grade A pancreatic fistula in 8 patients （44.4%） and grade B pancreatic fistula in 2 patients（11.1%）, and were all cured by conservative treatment. Conclusion： Kimura’s procedure for benign and borderline tumors in the body and tail of the pancreas is safe and feasible, and thorough preoperative preparation, sophisticated laparoscopic techniques and good cooperative abilities, especially the meticulous splenic vessel separating and suturing techniques are essential for completing the operation.