腹腔镜保脾胰体尾切除术临床疗效

Clinical efficacy of laparoscopic spleen-preserving pancreatectomy

目的探讨腹腔镜保脾胰体尾切除术的临床应用价值。方法回顾性分析2015年1月至2017年12月在吉林大学第一医院行腹腔镜胰体尾切除的41例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男9例,女32例;年龄9~68岁,中位年龄42岁。患者均为胰腺体尾部良性或交界性肿瘤。根据手术方式不同将患者分为保脾组(32例)和切脾组(9例)。保脾组根据情况采用Warshaw法或Kimura法保脾胰体尾切除术,切脾组行胰体尾切除术联合脾切除术。两组手术情况比较采用Mann-Whitney U检验。率的比较采用χ^2检验。结果所有患者均顺利完成手术,其中保脾组中采用Warshaw法22例,Kimura法10例。保脾组术中出血量中位数为60(20~200)ml,明显低于切脾组的160(85~280)ml(U=-4.137,P<0.05)。Warshaw法患者术中出血量55(20~110)ml,明显低于Kimura法患者的110(30~200)ml(U=-2.842,P<0.05)。保脾组与切脾组胰瘘发生率分别为28%、9%,差异无统计学意义(χ^2=0.125,P>0.05)。术后随访时间1~24个月,患者生活质量好,未见肿瘤复发。结论腹腔镜保脾胰体尾切除术对于治疗胰体尾部的良性或交界性肿瘤安全有效,与Kimura法相比,Warshaw法具有术中出血量少的优势。

Objective To explore the clinical application value of laparoscopic spleen-preserving pancreatectomy.Methods Clinical data of 41 patients who underwent laparoscopic distal pancreatectomy in the First Hospital of Jilin University from January 2015 to December 2017 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,9 patients were male and 32 female,aged 9-68 years with a median age of 42 years.All patients were diagnosed with benign or borderline tumors of the distal pancreas.The patients were divided into the spleen-preserving group(n=32)and splenectomy group(n=9)according to different surgical procedures.In the spleen-preserving group,Warshaw or Kimura spleen-preserving pancreatectomy was adopted,whereas distal pancreatectomy combined with splenectomy was performed in the splenectomy group.The surgical conditions were statistically compared between two groups by Mann-Whitney U test.The rate comparison was conducted by Chi-square test.Results All patients completed the operation successfully,including 22 cases of Warshaw technique and 10 cases of Kimura technique in the spleen-preserving group.The median intraoperative blood loss in the spleen-preserving group was 60(20-200)ml,significantly lower than 160(85-280)ml in the splenectomy group(U=-4.137,P<0.05).The intraoperative blood loss in patients treated with Warshaw technique was 55(20-110)ml,significantly less than 110(30-200)ml of those with Kimura technique (U=-2.842, P<0.05). The incidences of pancreatic fistula in the spleen-preserving and splenectomy groupswere 28% and 9%, respectively, where no significant difference was observed (χ^2=0.125, P>0.05). Thepostoperative follow-up time was 1-24 months. All patients lived high quality of life and no tumor recurrencewas found. Conclusions Laparoscopic spleen-preserving pancreatectomy is a safe and efficacious treatmentfor benign or borderline tumors of distal pancreas. Compared with the Kimura technique, Warshaw techniquecauses less intraoperative blood loss.