腹腔镜胰体尾切除术治疗胰体尾良性及低度恶性肿瘤

Laparoscopic distal pancreatectomy for pancreatic benign and low-grade malignant tumor

目的探讨腹腔镜胰体尾切除术治疗胰体尾良性及低度恶性肿瘤技术要点。方法回顾性分析2015年1月至2017年3月山西医科大学第一医院行腹腔镜胰体尾切除术（laparoscopic distal pancreatectomy, LDP）治疗胰体尾良性及低度恶性肿瘤21例患者的临床资料。结果21例患者均顺利完成手术，1例患者中转开腹（4．76％），13例完成腹腔镜保留脾脏胰体尾切除术（laparoscopic spleen-preserving distal pancreatectomy, LSPDP）（61．90％），LSPDP均采用保留脾动静脉的保脾方法（Kimura法），其余7例行腹腔镜联合脾脏的胰体尾切除术（33．33％）。肿瘤平均大小为（6．0±3．1）cm；手术时间为190—421（288．4±56．9）min；出血量为30—800（235．7±202．6）ml，患者住院时间为6～17（8．9±3．1）d。术后6例患者出现A级胰漏，保守治疗后痊愈出院。结论对胰体尾良性或低度恶性肿瘤可以施行腹腔镜下保留脾脏的胰体尾切除术。

Objective To explore the surgical techniques in laparoscopie distal pancreateetomy for benign and low malignant tumors in the body or tail of the pancreas. Methods The clinical data of 21 cases of benign and low-malignant tumors in the body or tail of the pancreas undergoing LDP from Jan 2015 to Mar 2017 in the First Hospital of Shanxi Medical University were analyzed retrospectively. Results One patient was converted to open surgery（4. 76% ）, 13 patients underwent laparoseopie spleen-preserving distal pancreatectomy （ Kimura procedure）. The other 7 patients underwent LDP with spleneetomy. The average size of the tumor was （6. 0 ±3. 1）era; the operation time was 190 to 421 mins with mean time of （288. 4 ±56. 9）rain; the intraoperative blood loss was 30 to 800 ml with the mean volume of（235.7 ±202. 6）ml; Postoperative hospital stay was 6 to 17 days with the mean time of （ 8.9 ±3. 1 ） days. Six patients suffered from type A pancreatic fistula, and were cured by conservative treatment. Conclusions Laparoscopic spleen-preserving pancreatectomy for benign or low-grade malignant body and tail pancreatic tumors is feasible and safe.