腹腔镜保留脾脏胰体尾切除术的关键技术

Strategies and Technical Aspects of Laparoscopic Splenic-preserving Distal Pancreatectomy

腹腔镜保留脾脏胰体尾切除术适用于胰体尾部良性或低度恶性病变,避免了脾切除术后近、远期并发症,手术方式包括保留脾动静脉的Kimura手术和切除脾动静脉主干、保留胃网膜左血管等侧枝循环的Warshaw手术。腹腔镜下Kimura手术视野清晰,安全可行,术后并发症发生率低,应为保脾胰体尾切除手术的首选。术前检查或术中探查可疑为浸润性恶性病变或病灶与脾血管、脾门关系密切者,应果断放弃保脾术式,改行胰体尾联合脾切除术。

For the potential long-and short-term complications associated with splenectomy, laparoscopic spleen-preserving distal pancreatectomy(Lap SPDP) is a feasible and comparably safe approach for the surgical treatment of benign or low-grade malignant tumors in the body and tail of the pancreas. Lap SPDP could be accomplished by using either the Kimura’s or the Warshaw technique, In Kimura’s technique, the integrity of both the splenic artery and vein are preserved, while in the Warshaw’s technique, main trunk of splenic artery and vein are ligated and dissected with preservation of left gastroepiploic artery. Laparoscopic Kimura’s procedure coulf be performed safely by experienced surgeon, with low incidence of splenic necrosis or abscess formation. However, in case of close adhesion of tumour with vessels or splenic hilar, combined splenectomy should be performed in time.