腹腔镜下保脾治疗胰体尾部良、交界性病变的临床研究

Clinical study of laparoscopic spleen-preserving therapy for benign and borderline lesions at the body and tail of the pancreas

目的:探讨腹腔镜技术治疗胰腺良性、交界性病变的应用价值及保留脾脏的意义。方法:回顾分析2010~2018年行胰体尾切除术的34例患者的临床资料,分别行腹腔镜下保留脾脏胰体尾切除术(A组,n=8)、腹腔镜下不保留脾脏的胰体尾切除术(B组,n=8)、保留脾脏胰体尾切除术(C组,8例)及不保留脾脏的胰体尾切除术(D组,n=10)。比较各组手术相关指标、术后恢复及术后并发症等。结果:在保脾的情况下,A组手术时间长于C组(P<0.05),但术中出血量、术后并发症少,术后康复快(P<0.05)。在不保留脾脏的情况下,B组术中出血量、术后并发症少于D组(P<0.05),两组手术时间、术后恢复指标差异无统计学意义(P>0.05)。在使用腹腔镜的情况下,A组与B组手术时间、术后恢复指标差异无统计学意义(P>0.05),但前者术后并发症更少(P<0.05)。在开腹手术的情况下,C组与D组手术时间、术后恢复指标差异无统计学意义(P>0.05),但C组术后并发症少(P<0.05)。结论:使用腹腔镜技术治疗胰体尾良性、交界性病变具有良好的应用价值,而术中保留脾脏较不保留脾脏的患者有着更多获益。

Objective:To study the application value of laparoscopy in benign and borderline pancreatic lesions and the significance of spleen preservation.Methods:The clinical data of 34 patients of pancreatic body and tail resection from 2010 to 2018 were retrospectively analyzed.The operative methods were laparoscopic spleen-preserving pancreatic body-tail resection(group A,8 cases),laparoscopic non-spleen-preserving pancreatic body-tail resection(group B,8 cases),spleen-preserving pancreatic body-tail resection(group C,8 cases)and non-spleen-preserving pancreatic body-tail resection(group D,10 cases).Relevant surgical indicators,postoperative recovery and complications were compared among the groups.Results:Under the condition of preserving spleen,the operation time of group A was longer than that of group C(P<0.05),but the bleeding during operation and postoperative complications were less and the recovery was faster after operation(P<0.05).Without retaining the spleen,the amount of intraoperative bleeding and postoperative complications in group B were less than those in group D(P<0.05),but there was no significant difference in operation time and recovery between the two groups(P>0.05).In the case of laparoscopy,there was no significant difference in operation time and recovery between group A and group B(P>0.05),but the former had fewer complications(P<0.05).In the case of open surgery,there was no significant difference in operation time and recovery between group C and group D(P>0.05),but there were fewer complications in group C(P<0.05).Conclusions:Laparoscopic resection of the pancreatic body and tail has good application value,and patients with spleen preservation in pancreatic body and tail resection has more benefits than patients without spleen preservation.