腹腔镜保留脾脏的胰体尾切除术的意义与评价

The significance and evaluation of laparoscopic splenic-preserving distal pancreatectomy

随着腹腔镜技术的不断进步及保留脏器功能理念的重视,腹腔镜保留脾脏的胰体尾切除术的安全性及可行性已得到了广泛认可。该术式对于胰体尾部的良性及低度恶性肿瘤具有良好的治疗效果,它分为Kimura法和Warshaw法。Kimura法虽手术难度高且术中风险大,但术后并发症的发生率较低,宜为首选。本文结合实际临床经验及新近理念,对腹腔镜保留脾脏的胰体尾切除术的术式选择、适应证、技术要点及术后并发症的防治等进行论述与评价,以期供更多外科医生借鉴与参考。

With the development of laparoseopic technology- and the concept of spleen preservation, the safety and feasibility of laparoscopic splenic-preserving distal pancreatectomy have been widely recognized . Laparoscopic splenic-preserving distal pancreatectomy for benign and low-grade malignant tumor of the distal pancreas could achieve better short-term and long-term outcome. Two alternative techniques are discussed for spleen preservation, including sparing of the splenic vessels （ Kimura procedure） and sacrifice of the splenic artery and vein （ Warshaw procedure） . Although Kimura procedure involves considerable difficulties and high risks, it reduces the incidence of postoperative complications and should be the preferred approach. Based on clinical experience and newly concepts, this article discusses and evaluates the operation selection, indications, technical points and the prevention and treatment of postoperative complications of laparoscopic splenic-preserving distal pancreatectomy for more doctors.