腹腔镜全胰腺切除联合脾切除术(附视频)

Laparoscopic total pancreatectomy combined with splenectomy(video attached)

目的探讨腹腔镜全胰腺切除联合脾切除术的可行性与安全性。方法回顾性分析2017年7月广东省佛山市第一人民医院1例腹腔镜全胰腺切除联合脾切除术患者临床资料。患者女,53岁,因体检发现全胰腺多发囊性占位1周入院。入院诊断:胰腺导管内粘液性乳头状瘤。患者签署知情同意书,符合医学伦理规定。采用五孔法行腹腔镜全胰腺切除联合脾切除术,胰腺呈多发囊性改变,胰尾组织与脾静脉粘连紧密,离断胰颈后分别行胰体尾联合脾切除和胰十二指肠切除术,最后行肝总管-空肠端侧吻合术和胃-空肠吻合术。结果手术过程顺利,手术时间8.5 h,术中出血250 ml。术后使用胰岛素严格控制血糖,补充胰酶制剂促进消化。术后除出现一过性胃排空延迟外,无其他围手术期并发症。术后病理学检查示浆液性微囊腺瘤,术后住院时间28 d。出院后继续给予胰岛素皮下注射控制血糖,口服胰酶制剂促进消化,术后随访6个月,患者血糖基本控制平稳,无其他并发症。结论对于全胰性病变,腹腔镜全胰腺切除联合脾切除术是安全、可行的,术后应加强血糖控制,补充胰酶制剂。

Objective To investigate the feasibility and safety of laparoscopic total pancreatectomy combined with splenectomy.Methods Clinical data of one patient undergoing laparoscopic total pancreatectomy combined with splenectomy in First People's Hospital of Foshan in July 2017 were retrospectively analyzed.The female patient,aged 53 years,was hospitalized due to multiple cystic masses in the whole pancreas found by physical examination for one week.The patient was diagnosed with intraductal mucinous papilloma of the pancreas.The informed consent of the patient was obtained and the local ethical committee approval was received.Laparoscopic total pancreatectomy combined with splenectomy was performed with five-port approach.Multiple cystic change in the pancreas and tight adhesion between cauda pancreatis and splenic vein were observed.After the pancreatic neck was cut off,distal pancreatectomy combined with splenectomy and pancreaticoduodenectomy were performed.Finally,the common hepatic duct-jejunal end-to-side anastomosis and stomach-jejunostomy were performed.Results The operation was successfully conducted.The operation time was 8.5 h and the intraoperative bleeding was 250 ml.Postoperatively,insulin was administered to strictly control the glucose level and pancreatin was supplemented to promote digestion.No perioperative complication except temporary delayed gastric emptying was noted.Postoperative pathological examination revealed serous microcystadenoma.The length of postoperative hospital stay was 28 d.After discharge,insulin was injected subcutaneously to control the glucose level and trypsin was orally taken to promote digestion.During postoperative 6-month followup,the glucose was controlled at stable level without other complications.Conclusions Laparoscopic total panpancreatectomy combined with splenectomy is safe and feasible for pan-pancreatic diseases.The glucose level should be properly controlled and the pancreatin should be supplemented after operation.