机器人保留脾血管的胰体尾切除术在2例儿童胰腺肿瘤中的应用

Clinical application of robotic spleen preserving distal pancreatectomy for children with pancreatic neoplasm of the body and tail

目的探讨机器人保留脾血管胰体尾切除术在儿童胰体尾良性及低度恶性肿瘤治疗中的临床应用。方法对2016年7月-2018年10月我院收治的2例胰体尾肿瘤儿童实施机器人保留脾血管的胰体尾切除术。患儿1,女性,9岁,24 kg,120 cm,诊断为胰体尾胰岛素瘤;患儿2,女性,11岁,35.5 kg,154 cm,诊断为胰体尾实性假乳头状瘤。均行Da Vinci机器人保留脾血管的胰体尾切除术。结果手术历时分别为155 min及150 min,气腹时间120 min,术中失血分别为10 ml及50 ml。胰岛素瘤患儿空腹血糖正常,空腹胰岛素及血糖比值小于0.4,围术期恢复顺利,无胰瘘、出血及腹腔感染等并发症。随访2年3个月,无肿瘤复发。实性假乳头状瘤患儿围术恢复顺利,进低脂半流食,无腹部不适。结论机器人保留脾血管的胰体尾切除术用于儿童胰腺体尾部良性及低度恶性肿瘤的手术治疗安全、可行;限制性胰体尾及肿瘤切除是儿童胰腺体尾部良性及低度恶性肿瘤机器人手术治疗应该遵循的原则。

Objective To explore the safety and feasibility of robotic spleen preserving distal pancreatectomy with conservation of spleen vessels for children who suffered from benign or low-grade malignant pancreatic tumor of the body and tail. Methods From July 2016 to October 2018, 2 children with benign or low-grade malignant pancreatic tumor of the body and tail underwent Da Vinci robotic distal pancreatectomy with conservation of splenic vessels. Case 1 was a 9-year-old girl who suffered from insulinoma with weight of 24 kg and height of 120 cm. Case 2 was a 11-year-old girl who suffered from solid pseudopapillary tumor with weight of 35.5 kg and height of 154 cm. Intraoperative indicators and clinical outcomes were assessed. Results The operating time was 155 minutes and 150 minutes, respectively, and the pneumoperitoneum time was 120 minutes. The intraoperative blood loss was 10 ml and 50 ml, respectively. They experienced uneventful recovery postoperatively, without pancreatic fistula, bleeding and infection, et al. No complications related to pneumoperitoneum occurred. The blood glucose in the girl suffered from insulinoma was restored to a normal level, with a ratio of fasting insulin to glucose less than 0.4. She was followed up for 2.25 years, without tumor recurrence.The girl suffered from solid pseudopapillary tumor took low fat diet without abdominal discomfort. Conclusion Robotic spleen preserving distal pancreatectomy with conservation of spleen vessels is safe and feasible for children who suffered from benign or low grade malignant pancreatic tumor of the body and tail. Limited distal pancreatectomy should be a principle for this surgery.