腹腔镜保留脾脏胰体尾切除术治疗胰体尾部良性肿瘤及部分交界性肿瘤的临床效果

Clinical effect of laparoscopic splenic-preserving pancreaticocaudectomy in the treatment of benign tumors and some borderline tumors of the pancreatic body and tail

目的:探究离断脾血管而保留胃短血管的胰体尾切除术(Warshaw法)和保留脾动静脉的胰体尾切除术(Kimura法)对胰体尾部良性肿瘤及部分交界性肿瘤的临床应用效果。方法:回顾性分析2015年1月至2018年10月收治的60例因胰体尾部良性肿瘤及部分交界性肿瘤行腹腔镜保脾胰体尾切除术患者的临床资料,根据手术方式不同分为Kimura组(行Kimura法胰体尾切除术,n=34)和Warshaw组(行Warshaw法胰体尾切除术,n=26)。应用软件SPSS 23.0进行数据分析,术后并发症以[例(%)]表示,组间比较采用χ^(2)检验;围手术期指标等计量资料用(^(-)x±s)表示,采用独立样本t检验。P<0.05为差异有统计学意义。结果:Kimura组患者术中出血量多于Warshaw组(P<0.05),但两组患者手术时间、术后肛门通气时间和住院时间差异无统计学意义(P>0.05);Kimura组患者并发症总发生率低于Warshaw组(5.9%vs.34.6%,P<0.05);术后随访两组患者均无肿瘤复发及胃静脉曲张破裂出血发生。结论:腹腔镜保留脾脏胰体尾切除术应用于治疗胰体尾部良性肿瘤及部分交界性肿瘤近远期效果优良。与Warshaw法相比,Kimura法出血量虽多,但有利于脾脏血供及功能保护,术后并发症更低,具有一定优势,值得在临床推广应用。

Objective To investigate the clinical effects of Warshaw and Kimura resection of splenic arterio-venous resection in the treatment of benign and borderline pancreatic tumors.Methods Clinical data of 60 patients treated from January 2015 to October 2018 who underwent laparoscopic caudectomy due to benign pancreatic body and tail tumors and some borderline tumors were retrospectively selected and divided into Kimura group according to different surgical methods(Kimura method caudectomy,n=34 cases)and Warshaw group(Warshaw coyotectomy,n=26 cases).SPSS 23.0 software was used for data analysis.Postoperative complications were represented as[cases(%)],andχ^(2)test was used for comparison between groups.Measurement data such as perioperative indicators were represented by(^(-)x±s),and independent sample t test was used.P<0.05 was considered statistically significant.Results The amount of intraoperative blood loss in Kimura group was higher than that in Warshaw group(P<0.05),but there was no significant difference in operative time,postoperative anal ventilation time and hospital stay between the two groups(P>0.05).The total complication rate in Kimura group was lower than that in Warshaw group(5.9%vs.34.6%,P<0.05).No tumor recurrence or gastric varicose bleeding occurred in both groups during postoperative follow-up.Conclusion Laparoscopic splenic-preserving pancreato-caudal resection is effective in the treatment of benign tumors and some borderline tumors.Compared with Warshaw method,Kimura method has more blood loss,but it is beneficial to spleen blood supply and functional protection,and has lower postoperative complications,which has certain advantages and is worthy of clinical application.