腹腔镜下保留脾脏胰体尾切除术技术探讨及临床应用体会

Discussion and clinical application experience of laparoscopic spleen-preserving distal pancreatectomy technology

目的总结腹腔镜下保留脾脏胰体尾切除术(laparoscopic spleen-preserving distal pancreatectomy,LSPDP)的关键技术要点、适用性、可行性及安全性。方法回顾性分析川北医学院附属医院2016年9月至2019年11月期间收治的22例拟行LSPDP患者的临床资料。结果22例患者中顺利完成LSPDP 20例,2例中转开腹。1例因术中损伤脾动脉而中转开腹缝合损伤的脾动脉,察脾脏无缺血表现,继续行保脾手术;1例因腹腔重度粘连、解剖游离胰腺体尾部困难而中转开腹。20例行LSPDP患者的手术时间(191±86)min(170~480 min),术中失血量(365±50)mL(200~1000 mL),术后住院时间(9.9±2.6)d(7~16 d)。22例患者术后发生胰瘘6例,其中生化瘘3例,经对症治疗后痊愈出院;B级胰瘘3例,经抗炎、抑酸、抑酶和双导管冲洗引流后均治愈。术后获访20例,随访时间3~24个月(中位数为15个月),随访期间所有患者均未复发和转移。结论在严格筛选合适的病例、术前充分影像评估、术中精细操作及应用合适的操作器械及切割闭合器条件下,LSPDP治疗胰腺体尾部良性肿瘤及部分交界性肿瘤是安全和可行的,术中需注意对脾动、静脉的合理处理和保护。

Objective To summarize the key technical points,applicability,feasibility,and safety of laparoscopic spleen-preserving distal pancreatectomy(LSPDP).Method A retrospective analysis was performed for the clinical data of 22 patients who were admitted to the Affiliated Hospital of North Sichuan Medical College from September 2016 to November 2019,all patients planned to receive LSPDP.Results Twenty of the 22 patients successfully completed LSPDP,and 2 patients converted to laparotomy.One patient was transferred to laparotomy to suture the damaged splenic artery.The spleen was observed to have no ischemia and the spleen preservation operation was continued.One patient was converted to laparotomy due to the difficulty of dissecting the tail of the pancreas which caused by severe abdominal adhesion.The operation time of LSPDP patients was(191±86)minutes(170–480 min),intraoperative blood loss was(365±50)mL(200–1000 mL),and postoperative hospital stay was(9.9±2.6)days(7–16 d).Six patients of pancreatic fistula occurred after operation,including 3 cases of biochemical fistula,which were cured and discharged after symptomatic treatment,3 cases of grade B pancreatic fistula,who all improved after anti-inflammatory,acid suppression,enzyme suppression,and double catheter drainage.Twenty patients were interviewed after the operation,and the follow-up time was 3–24 months(median of 15 months).During the follow-up period,no patient had recurrence or metastasis.Conclusions Under the conditions of strict screening of suitable cases,adequate preoperative imaging evaluation,intraoperative fine manipulation,and the application of appropriate operating instruments and cutting closure devices,LSPDP is safe and feasible to treat benign tumors of the pancreatic body and tail and some borderline tumors.During the operation,attention should be paid to the reasonable treatment and protection of splenic arteries and veins.