完全腹腔镜下保留脾脏胰体尾切除术12例经验

邱福南，吴嘉艺，田毅峰，赖智德，周松强，严茂林，陈忠，王耀东^*

（福建省立医院肝胆外科，福州 350001）

（福建医科大学省立临床医学院，福州 350001）

摘要：目的  探讨完全腹腔镜下保留脾脏胰体尾切除术（SPLDP）在治疗胰腺体尾部占位的安全性、可行性及操作技巧。方法  回顾分析2008年10月至2012年12月完成的完全腹腔镜下SPLDP治疗胰体尾部占位12例（其中11例行Kimura法保留脾脏，1例行Warshaw法保留脾脏）的临床资料进行回顾性分析。结果  12例SPLDP无中转开腹，平均手术时间172.5min（120～240min）,术中平均出血量191.7ml（50～400ml），术后平均住院时间9.5天（4～25天），3例术后出现B级胰瘘，经充分引流后治愈。术后病理诊断胰腺实性假乳头状瘤4例，胰腺神经内分泌癌2例，胰岛细胞瘤2例，胰腺假性囊肿2例，胰腺囊腺瘤2例。术后随访6～51个月，效果良好，均未出现糖尿病和肿瘤复发。结论  对良性及低度恶性胰体尾肿瘤，完全腹腔镜下SPLDP是安全可行的。

关键词：腹腔镜；胰体尾切除术；保留脾脏；胰腺肿瘤

作者简介：邱福南（1972-  ），硕士，副主任医师，副教授，主要从事肝胆胰外科临床与基础研究。

通讯作者：王耀东，电子邮箱：qiufunan@medmail.com.cn。

Spleen-preserving laparoscopic distal pancreatectomy (SPLDP): with 12 cases from a single institution

QIU Funan, WU Jiayi, TIAN Yifeng, LAI Zhide, ZHOU Songqiang, YAN Maolin, CHEN Zhong, WANG Yaodong. (Department of Hepatobiliary Surgery, Fujian Provincial Hospital, Fuzhou 350001, China), ( Department of Surgery, Provincial Clinical College of Fujian Medical University)

Abstract:Objective  To explore the safety and advantages of Spleen-preserving laparoscopic distal pancreatectomy (SPLDP) in the treatment of the tumor in the body and tail of the pancreas. Methods  The medical records of 12 consecutives patients who had a SPLDP at Fujian Provincial Hospital from October 2008 to December 2012 (11 preserved the spleen by Kimura method, another one preserved the spleen by Warshaw method). Results  All patients successfully underwent SPLDP with an average operative time 172.5min (120 ~ 240min) and a mean intraoperative blood loss of 191.7ml (50 ~ 400ml), the mean postoperative length of stay is 9.5 days (4~25 days). 3 patient had a grade B pancreatic fistula, which resolved conservatively. The most common postoperative diagnosis was solid pseudopapillary tumor of pancreas in 4 patients, followed by pancreatic islet cell tumor in 2 patients, pancreatic pseudocysts in 2 patient, serous cystadenoma of pancreas in 2 patient, and pancreatic neuroendocrine carcinoma in 2 patient. Follow-up was available in all the patients form 6 to 51 months, during the period, no diabetes and recurrence was detected. Conclusions  SPLDP is safe and feasible in the treatment of  benign and low-grade malignant pancreatic diseases. 

Key words: Laparoscopy; Distal-pancreatectomy; Splenic Preservation; Pancreatic tumor