腹腔镜胰体尾切除术49例报告

Laparoscopic distal pancreatectomy:report of 49 cases

目的:探讨腹腔镜胰体尾切除术的可行性及临床应用价值。方法:回顾分析2014年6月至2018年6月行腹腔镜胰体尾切除术49例患者的临床资料,其中男13例,女36例;25~72岁,平均(44.7±15.3)岁。结果:37例行腹腔镜胰体尾联合脾脏切除术,肿瘤直径(44.6±20.3)mm;12例采用Kimura法行腹腔镜保留脾脏胰体尾切除术(LSPDP),肿瘤直径平均(29.5±20.2)mm。21例良性、交界性及低度恶性肿瘤行腹腔镜胰体尾联合脾脏切除术,肿瘤直径平均(47.5±21.2)mm,其中8例肿瘤直径≤40 mm,13例>40 mm;10例良性、交界性及低度恶性肿瘤患者行LSPDP,肿瘤直径平均(45.8±16.3)mm,其中8例肿瘤直径≤40 mm,2例>40 mm。两组患者肿瘤直径差异无统计学意义,良性、交界性及低度恶性胰腺肿瘤患者,肿瘤直径>40 mm时,多与脾脏动静脉关系密切,不宜实施Kimura法保留脾血管LSPDP(χ^2=4.763,P=0.029)。49例腹腔镜胰体尾切除术患者中46例发生生化漏,3例B级胰瘘,无C级胰瘘发生,腹腔镜胰体尾切除术不增加手术并发症的发生风险。37例腹腔镜胰体尾联合脾脏切除术患者术后肛门排气时间平均(3.4±0.8)d,术后平均住院(11.6±2.8)d;12例LSPDP患者术后肛门排气时间平均(3.3±0.8)d,术后平均住院(10.2±2.0)d。两组患者术后肛门排气时间、住院时间差异无统计学意义(t=0.51,P=0.61;t=1.68,P=0.10)。结论:对于胰体尾良性、交界性或低度恶性肿瘤,选择腹腔镜胰体尾切除术是安全、可靠的,患者创伤小,术后康复快。

Objective:To evaluate the feasibility and clinical application value of laparoscopic distal pancreatectomy(LDP).Methods:The clinical data of patients who underwent LDP from Jun.2014 to Jun.2018 were reviewed.A total of 49 patients were included in this study,including 13 males and 36 females,with the age ranging from 25 to 72(44.7±15.3)years old.Results:Thirty-seven patients underwent laparoscopic distal pancreatectomy with splenectomy(LDPS)with tumor diameter of(44.6±20.3)mm.Laparoscopic spleen-preserving distal pancreatectomy(LSPDP)was performed in 12 patients with tumor diameter of(29.5±20.2)mm by Kimura method.A total of 21 patients with benign,borderline and low-grade malignant tumors received LDPS,with tumor diameter of(47.5±21.2)mm.Tumor diameter was≤40 mm in 8 patients,and tumor diameter was>40 mm in 13 patients.There were 10 patients with benign,borderline and low-grade malignant tumors underwent LSPDP with tumor diameter of(45.8±16.3)mm:8 patients with tumor diameter≤40 mm,and 2 patients with tumor diameter>40 mm.There was no significant difference in tumor diameter between the two groups.When the diameter of benign,borderline and low-grade malignant pancreatic tumor was>40 mm,it was mostly adherent to the arteries and veins of the spleen.It is not suitable to use Kimura method to preserve splenic vessels for LSPDP(χ^2=4.763,P=0.029).Among the 49 LDP patients,there were 46 cases with biochemical leak,3 cases with B-grade pancreatic fistula,and no C-grade pancreatic fistula occurred,LDP did not increase the risk of surgical complications.The postoperative anal exhaust time of 37 LDPS patients was(3.4±0.8)d,and the postoperative hospitalization time was(11.6±2.8)d.The postoperative anal exhaust time of 12 LSPDP patients was(3.3±0.8)d,and the postoperative hospitalization time was(10.2±2.0)d.There was no significant difference in postoperative anal exhaust time or postoperative hospital stay between the two groups(t=0.51,P=0.61;t=1.68,P=0.10).Conclusions:For benign,borderline or low grade malignant tumors in the body and tail of the pancreas,LDP is safe and reliable with minimal invasion and rapid recovery.