BACKGROUND： Minimally invasive spleen-preserving distal pancreatectomy （SPDP） can be performed with either splenic vessel preservation （SVP） or resection [Warshaw procedure （WP）]. The aim of this study was to e...BACKGROUND： Minimally invasive spleen-preserving distal pancreatectomy （SPDP） can be performed with either splenic vessel preservation （SVP） or resection [Warshaw procedure （WP）]. The aim of this study was to evaluate the postoperative clinical outcomes of patients undergoing both methods. DATA SOURCES： Database search of PubMed, Embase, Scopus, Cochrane, and Google Scholar was performed （2000-2014）; key bibliographies were reviewed. Qualified studies compar- ing patients undergoing SPDP with either SVP or WP, and as- sessing postoperative complications were included. Calculated pooled risk ratio （RR） with the corresponding 95% confidence interval （CI） by random effects methods were used in the meta-analyses. RESULTS： The search yielded 215 studies, of which only 14 observational studies met our selection criteria. The studies included 943 patients in total; 652 （69%） underwent SVP and 291 （31%） underwent WP. Overall, there was a lower incidence of splenic infarction （RR=0.17; 95% Ch 0.09-0.33; P〈0.001）, gastric varices （RR=0.16; 95% Ch 0.05-0.51; P=0.002）, and intra/postoperative splenectomy （RR=0.20; 95% Ch 0.08-0.49; P〈0.001） in the SVP group. There was no difference in in- cidence of pancreatic fistula （WP vs SVP, 23.6% vs 22.9%;P=0.37）, length of hospital stay, operative time or blood loss. There was moderate cross-study heterogeneity. CONCLUSIONS： SVP is a safe, efficient and feasible technique that may be used to preserve the spleen. WP may be more suit- able for large tumors dose to the splenic hilum or those associ- ated with splenomegaly. Randomized clinical trials are justified to examine the long-term benefits of SVP-SPDP.展开更多
文摘目的?探讨腹腔镜Warshaw技术(laparoscopic Warshaw technique,lap-WT)在胰腺远端切除术保脾中的安全性。研究对于脾脏血管上附有大肿瘤患者预先计划lap-WT或尽早转换为lap-WT治疗的有效性。方法 2008年1月至2019年8月在周口市中心医院行腹腔镜下胰腺远端切除术的171例患者中,42例(24.6%)行lap-WT。42例患者按时间分为早期组(2008年1月至2016年12月,n=22)和晚期组(2017年1月至2019年8月,n=20)。其中早期组为保留脾血管失败后最后才转换为lap-WT的患者;晚期组为预先计划或尽早转换为lap-WT的患者。结果 42例患者中位手术时间181.1 min(141~223 min),中位出血量318.7 mL(125~498 mL),术后平均住院9.0 d(7~11 d)。术后发生并发症9例(21.4%),其中4例(9.5%)伴有胰瘘(ISGPF分级B、C);术后因出血再次手术1例。中位随访时间35个月,42例均没有出现明显的脾脏梗死或胃静脉曲张;所有患者均保守观察。在晚期组与早期组的比较中,晚期组平均手术时间(161.0 min vs 225.0 min,P=0.001)和平均手术出血量(230.1 mL vs 380.0 mL,P=0.016)均显著低于早期组。而两组的总并发症发生率无明显差异(P=0.468),胰瘘发生率无明显差异(P=0.667)。两组间的脾脏梗死(P=0.745)和胃静脉曲张(P=0.468)的发生率无明显差异。结论在胰腺远端切除术中作为保存脾脏的一种方法,严格控制适应证,lap-WT技术在某些病例中是一种安全的治疗策略。预先计划或尽早转换为lap-WT能够缩短手术时间,减少出血量,且不增加相应并发症。
文摘BACKGROUND： Minimally invasive spleen-preserving distal pancreatectomy （SPDP） can be performed with either splenic vessel preservation （SVP） or resection [Warshaw procedure （WP）]. The aim of this study was to evaluate the postoperative clinical outcomes of patients undergoing both methods. DATA SOURCES： Database search of PubMed, Embase, Scopus, Cochrane, and Google Scholar was performed （2000-2014）; key bibliographies were reviewed. Qualified studies compar- ing patients undergoing SPDP with either SVP or WP, and as- sessing postoperative complications were included. Calculated pooled risk ratio （RR） with the corresponding 95% confidence interval （CI） by random effects methods were used in the meta-analyses. RESULTS： The search yielded 215 studies, of which only 14 observational studies met our selection criteria. The studies included 943 patients in total; 652 （69%） underwent SVP and 291 （31%） underwent WP. Overall, there was a lower incidence of splenic infarction （RR=0.17; 95% Ch 0.09-0.33; P〈0.001）, gastric varices （RR=0.16; 95% Ch 0.05-0.51; P=0.002）, and intra/postoperative splenectomy （RR=0.20; 95% Ch 0.08-0.49; P〈0.001） in the SVP group. There was no difference in in- cidence of pancreatic fistula （WP vs SVP, 23.6% vs 22.9%;P=0.37）, length of hospital stay, operative time or blood loss. There was moderate cross-study heterogeneity. CONCLUSIONS： SVP is a safe, efficient and feasible technique that may be used to preserve the spleen. WP may be more suit- able for large tumors dose to the splenic hilum or those associ- ated with splenomegaly. Randomized clinical trials are justified to examine the long-term benefits of SVP-SPDP.
