腹腔镜下保留脾脏的全胰腺切除术1例报告并文献复习

Laparoscopic total pancreatectomy with spleen preservation:a case report and literature review

目的:探讨腹腔镜下保留脾脏的全胰腺切除术的安全性与可行性。方法:回顾分析2019年8月为1例患者行腹腔镜全胰腺切除术(保留脾脏)的临床资料。患者女,62岁,因体检发现胰头部占位2 d入院。术前诊断:胰腺头部占位(胰腺囊性假乳头状瘤?胰腺癌?)。探查胰腺病变及其与周围血管的关系,采用胰颈切开入路行胰十二指肠切除术,术中冰冻病理学检查提示:胰腺组织内可见癌浸润,行保留脾脏的胰腺体尾部切除术。完成胃肠吻合与肝总管空肠吻合。结果:手术过程顺利,手术时间11 h,术中出血300 mL。术后使用胰岛素泵与皮下注射胰岛素控制血糖,补充胰酶制剂。术后患者恢复顺利,无严重并发症发生。术后随访1个月,患者生活质量良好,血糖控制良好。术后病理示:全胰腺中分化导管腺癌。结论:腹腔镜下保留脾脏的全胰腺切除术治疗全胰腺病变是安全、可行的,围手术期应加强血糖控制,对胰腺内外分泌功能进行替代支持治疗。

Objective:To investigate the safety and feasibility of laparoscopic total pancreatectomy(spleen preservation).Methods:Retrospective analysis was made on the clinical data of one patient who underwent laparoscopic total pancreatectomy(spleen preservation)in Aug.2019.The patient,a 62-year-old woman,was admitted to the hospital because of a mass of pancreatic head found by physical examination in 2 days.Preoperative diagnosis was pancreatic head mass(cystic pseudopapilloma of the pancreas?Pancreatic cancer?).Laparoscopic exploration was used to explore the relationship between pancreatic lesions and peripheral blood vessels.Pancreatoduodenectomy was performed through the pancreatic neck incision.Intraoperative frozen-section examination revealed that there was cancer infiltration in pancreatic tissue,followed by pancreatic body,tail resection and preservation of spleen.Digestive tract reconstruction was completed with gastrointestinal anastomosis and hepatojejunostomy.Results:The operation process was successful.The operation time was 11 hours and the bleeding volume was 300 mL.Postoperatively,insulin pump and insulin subcutaneous injection were used to control glucose and pancreatin was supplemented.Postoperative recovery was smooth without serious surgical complications.Follow-up for 1 month showed good quality of life and good glucose control.Postoperative pathology revealed medium differentiated ductal adenocarcinoma of the pancreas.Conclusions:Laparoscopic pancreatectomy(spleen preservation)is safe and feasible for pancreatic lesions.Glucose control should be strengthened during perioperative period,and endocrine and excrine function of pancreas should be replaced by supportive treatment.