腹腔镜胰体尾切除术与开腹胰体尾切除术临床疗效对比分析

目的 对比腹腔镜胰体尾切除术（laparoscopic distal pancreatectomy,LDP）与开腹胰体尾切除术（open distal pancreatectomy,ODP）的疗效,探讨腹腔镜胰体尾切除术的优缺点.方法 回顾性分析2011年1月至2014年4月施行的17例腹腔镜胰体尾切除术患者与20例开腹胰体尾切除术患者的临床资料,对比两组患者的手术及术后情况.结果 腹腔镜组术中出血量少于开腹组,差异具有统计学意义（P＜ 0.05）;腹腔镜组术后肛门排气时间、禁食时间、住院时间较开腹组短,差异具有统计学意义（P＜0.05）;腹腔镜组手术时间长于开腹组,差异具有统计学意义（P＜0.05）;两组保脾率、术后并发症发生率差异无统计学意义（P＞ 0.05）,开腹组5例胰漏,1例切口感染、1例肺部感染、1例腹腔感染,腹腔镜组4例胰漏.结论 腹腔镜胰体尾切除术是安全可靠的,短期预后优于开腹组,值得临床进一步推广.     

胰体尾肿瘤原位手术切除体会

目的 探讨胰体尾部肿瘤原位切除的可行性及优越性.方法 自2003年2月～2006年11月对6例胰体尾部肿瘤进行了胰体尾部肿瘤的原位手术切除术.其中胰体尾部原发癌4例,转移癌2例.手术方法是在分离胰体尾部肿瘤和脾脏前,先在肿瘤的右侧离断胰腺、结扎切断脾动静脉及其与胃肠的交通支,再由右向左切除胰体尾部肿瘤、脾脏、Gerota's筋膜和受浸润的脏器.本组单纯的胰体尾部和脾脏切除2例,联合胃、横结肠系膜、左肾上腺等脏器切除4例.结果 本组6例均获得成功.手术时间120～240 min,平均180 min.无手术死亡,无严重的手术并发症,无术中大出血(平均出血量320 ml).结论 胰体尾部肿瘤原位切除术,在技术上是可行的.与传统的胰体尾肿瘤切除术相比,操作方便、安全,根治彻底,出血少.尤其适用于对累及邻近脏器的胰体尾肿瘤进行根治性联合脏器切除.     

腹腔镜胰体尾切除术6例报告

目的探讨腹腔镜胰体尾切除术（laparoscopic distal pancreatectomy,LDP）治疗胰体尾肿瘤的临床价值。方法2008年6月～2013年6月,行LDP6例,年龄33～76岁,平均45．8岁。其中胰腺体尾部实性占位4例,囊实性占位2例。结果手术均在全腹腔镜下一次成功。手术时间125～365min,平均250min。出血量50～350ml,平均168ml。术后病理报告胰腺浆液性囊腺瘤1例,黏液性囊腺瘤1例,囊腺癌4例。1例术后胰漏,经保持引流通畅、抑制胰酶分泌等保守治疗痊愈。术后住院5～19d,平均7．8d。结论LDP创伤小,术后恢复快,是治疗胰体尾肿瘤安全、可行的方法,但术者需有丰富的腹腔镜手术和胰腺外科手术经验。     

腹腔镜辅助逆行法胰颈体尾脾切除术

目的:探讨腹腔镜辅助逆行法胰体尾脾切除术的手术方法及适应证。方法:总结分析2010年5月至2012年10月为8例胰颈体恶性肿瘤患者行腹腔镜辅助逆行胰颈体尾脾切除术的临床资料,肿瘤侵犯周围重要血管,术前经增强CT、MR充分评估,肿瘤左侧胰体尾脾界清,无远处转移。术中腹腔镜完全游离肿瘤左侧胰体尾脾,再于上腹正中做8～10 cm切口,直视下处理胰颈肿瘤与周围重要血管的侵犯、粘连,于门静脉右侧缘离断胰颈部,完整切除、取出胰体尾脾。结果:8例均顺利完成腹腔镜辅助手术,手术时间100～180 min,术中出血量100～200 ml,术后患者恢复顺利。结论:腹腔镜辅助逆行法胰颈体尾脾切除术可作为侵犯周围重要血管但左侧胰体尾界清的胰颈体肿瘤的选择术式,具有患者创伤小、康复快、安全可行等优点。     

胰体尾切除术后胰瘘的相关性因素分析

目的探讨胰体尾切除术后胰瘘发生的相关性因素。方法回顾性总结了82例行胰体尾切除的患者术前、术中操作以及术后并发症和死亡率发生的情况,并分析和术后胰瘘发生的相关性因素。结果术后有36名患者出现并发症占43.9%（36/82）。其中胰瘘是最常见的并发症,发生率为37.8%（31/82）。其中是否结扎主胰管和术后胰瘘的发生具有明显的相关性（P=0.010）,而性别、年龄、是否并存糖尿病、胰腺的质地、术中失血量、是否预防性应用奥曲肽、是否用生物胶封闭胰腺断端、术后低蛋白血症和是否联合其它脏器切除均和胰瘘的发生无明显的相关性。结论胰体尾切除术后最常见的并发症仍然是胰瘘,术中单独结扎胰管可以减少胰瘘的发生率。     

全腹腔镜胰体尾切除术研究进展

[摘 要] 腹腔镜技术在胰腺外科的应用相对比较缓慢,且更具挑战性。随着腔镜手术器械的发展及术者手术经验的积累,腹腔镜胰体尾切除术在越来越多的肝胆胰诊疗中心相继开展,腹腔镜保留脾脏的胰体尾切除术被大多胰腺外科医生青睐。本文就腹腔镜保留脾脏的胰体尾部切除术的适应证和禁忌证、Warshaw与Kimura两种术式的优劣及手术并发症的防治等研究进展进行综述。     

腹腔镜胰体尾切除术在基层医院的初步应用

目的 探讨腹腔镜胰体尾切除术（laparoscopic distal pancreatectomy,LDP）治疗胰体尾肿瘤在基层医院的临床价值.方法 对2006年9月至2012年6月间我院行LDP的3例手术病例资料进行回顾性分析.结果 3例患者手术顺利,均在完全腹腔镜下完成,其中2例同时行脾脏切除术,1例保留脾脏;手术时间180 ～260 min,出血量350 ～500 mL,术后住院时间10 ～ 17 d,术后无重大并发症发生.结论 LDP创伤小、术后恢复快,是治疗胰体尾肿瘤一种安全、可行的方法.     

腹腔镜胰体尾切除术的临床应用（附4例报告）

目的 探讨腹腔镜胰体尾切除术(laparoscopic distal pancreatectomy，LDP)治疗胰体尾肿瘤的临床价值。方法 2002年6月～2004年12月行LDP的患者4例(保留脾脏1例)，平均年龄39．8岁(31～48岁)。其中胰腺体尾部实性占位2例，囊实性占位2例。结果 手术均在全腹腔镜下一次成功，平均手术时间305min(95～465min)，平均出血140ml(50～300ml)。1例发生胰漏，经保守治疗痊愈。术后平均住院9．8d(5～18d)。结论 LDP创伤小、术后恢复快，是治疗胰体尾肿瘤安全、可行的方法。     

腹腔镜胰体尾切除术28例分析

目的探讨腹腔镜胰体尾切除术(laparoscopic distal pancreatectomy,LDP)的可行性及临床价值。方法回顾分析2014年5月至2016年9月28例施行LDP病人的临床资料。28例病人中,男性9例,女性19例,年龄17~69岁。结果 16例LDP联合脾脏切除,7例行Kimura法保脾LDP,5例行Warshaw法保脾LDP。术后病理:胰腺浆液性囊腺瘤2例,黏液性囊腺瘤9例,实性假乳头状瘤6例,导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)3例,胰岛素瘤3例,胰腺假性囊肿1例,慢性胰腺炎1例,胰腺癌3例。全组病人平均手术时间为(203±54)min;平均术中出血量为(115±138)ml。平均术后下床活动时间为(1.4±0.6)d;平均术后首次进食时间为(2.0±0.8)d;平均术后住院时间为(10±5)d。术后发生胰瘘9例(32.1%),其中A级胰瘘6例,未予特殊处理,自然痊愈;B级胰瘘3例,均经冲洗引流后痊愈。术后发生脾部分梗死2例,未予特殊处理,经3个月随访观察自然痊愈。结论 LDP安全可行,具有微创优势,值得推广应用。     

保留脾脏的胰体尾切除术

1913年Ｍａｙｏ在胰体尾部肿瘤手术中首创远端胰腺切除术 ,同时合并脾脏切除 ,并作为标准术式流传至今。但随着大量基础研究的深入和临床实践经验的积累 ,“脾脏不再是可有可无的器官 ,而是具有重要保护功能的免疫器官”这一概念已被广大临床医师所接受 ,无辜性脾切除应尽量避免。越来越多的手术病例证实保留脾脏的胰体尾切除术在技术上是完全可行的。一、保留脾脏的胰体尾切除术的解剖学基础胰体尾 -脾区解剖结构毗邻紧密 ,脾动静脉为胰体尾和脾脏解剖联系的纽带。由于脾动静脉与胰体尾、脾门与胰尾的紧密联系 ,胰体尾与脾脏常视为一个解剖…     

保留脾脏的胰体尾切除术28例报告

目的探讨保留脾脏的胰体尾切除术(SPDP)的可行性和手术技巧,比较SPDP与胰体尾、脾切除术(DP)患者的临床疗效。方法回顾性分析胰体尾切除术患者临床资料58例,其中DP30例(A组),SPDP28例(B组),B组又分为B1(保留脾血管组)和B2(合并脾血管切除组)两个亚组。比较两组在手术时间、术中出血量、术后并发症发生率及术后Α院时间的差异。结果 A、B组的手术时间、术中出血量、术后并发症发生率、胰瘘发生率、肺部感染发生率的组间差异均无统计学意义;SPDP组术后Α院时间明显较DP组短(P0.05)。B1亚组较B2亚组手术时间明显延长(P0.05);术中出血量、术后总的并发症发生率、胰瘘发生率、肺部感染发生率、术后Α院时间的差异无统计学意义。B1组与B2组的术后并发症发生率及术后Α院时间的差异无统计学意义。结论保留脾脏的胰体尾切除术不增加并发症发生率,而术后Α院时间缩短。保留脾血管㈦否对术后并发症发生率及术后Α院时间无影响。     

Clinical outcome of laparoscopic distal pancreatectomy

Background  Few studies have compared laparoscopic distal pancreatectomy (Lap-DP) and open distal pancreatectomy (open-DP). The aim of this study was to evaluate the clinical outcome of Lap-DP and compare it to that of open-DP. Methods  A total of 37 patients who underwent distal pancreatectomy (Lap-DP, 21 patients; open-DP, 16 patients) between January 2000 and March 2007 were enrolled in this study. Prior to January 2004, open-DP was the standard procedure for patients with a lesion in the distal pancreas without invasive ductal cancer; thereafter, Lap-DP was also an approved procedure. All 16 open-DP procedures were performed prior to January 2004. Results  The operating times for the Lap-DP and open-DP patients were 308.4 ± 124.6 and 281.5 ± 83.3 min, respectively, and these were not significantly different (P = 0.4635). Blood loss for the Lap-DP group (249.0 ± 239.8 ml) was significantly smaller than that for the open-DP group (714.1 ± 650.4 ml) (P = 0.0055), and none of the patients in the Lap-DP group received transfusions. The frequency of complications for the Lap-DP and open-DP groups was 0 and 18.8%, respectively, which is not significantly different (P = 0.0784). The average hospital stay for the Lap-DP group was significantly shorter than that for the open-DP group (10.0 ± 2.6 vs. 25.8 ± 8.8 days; P < 0.0001). Conclusion  In pancreatic diseases, other than invasive ductal cancer, arising in the distal pancreas, Lap-DP might be a more feasible and safer than open-DP.     

Middle-preserving pancreatectomy for synchronous ampullary carcinoma and solid-pseudopapillary tumor of distal pancreas

Introduction

Total pancreatectomy is the treatment of choice for multicentric diseases involving the pancreas. Middle-preserving pancreatectomy is a recently reported alternative procedure when the pancreatic body is spared from disease.

Presentation of case

We report a 63-year old lady who underwent a combined Whipple''s operation and distal splenopancreatectomy for her synchronous ampullary carcinoma and solid-pseudopapillary tumor of the distal pancreas.

Discussion

For multiple tumors of the pancreas, the choice of surgery should be based on the nature of pathology and follow the principle of oncological resection.

Conclusion

Middle-preserving pancreatectomy is a safe and feasible option for patient with multicentric or synchronous pancreatic pathologies.     

Laparoscopic distal pancreatectomy for inflammatory pseudotumor of the pancreas

An 82-year-old woman presented with abdominal pain, nausea, emesis, and weight loss of ~25 lb over 6 months. A CT scan and MRI of the abdomen revealed a mass in the tail of the pancreas that was suspicious for malignancy. The patient underwent successful laparoscopic distal pancreatectomy and was discharged home on the 4th postoperative day after an uneventful course. Pathology revealed an inflammatory pseudotumor of the pancreas (IPT). Pancreatic IPT is a rare entity, and this case represents the first report of laparoscopic resection of this lesion. The presentation, diagnosis, histologic features, and therapy of IPT of the pancreas are reviewed.     

Morbidity, mortality, and technical factors of distal pancreatectomy

BACKGROUND: Pancreatic leak is a major source of morbidity associated with pancreatic surgery. We sought to identify disease and technique-dependent factors associated with morbidity and mortality after distal pancreatectomy. METHODS: Retrospective review of patients who underwent distal pancreatectomy during a 5-year period. Clinical, technical, and pathologic data were correlated with operative morbidity or mortality. RESULTS: Fifty-one patients underwent distal pancreatectomy for primary pancreatic disease, extrapancreatic malignancy, or trauma. Overall perioperative mortality and morbidity rates were 4% and 47%, respectively. Pancreatic leak was the most common complication, occurring in 26% of patients. Overall complications and pancreatic leaks occurred more often after distal pancreatectomy for trauma and in patients with a sutured pancreatic stump closure. CONCLUSIONS: Distal pancreatectomy can be performed with a low rate of mortality, though pancreatic leak is a common cause of morbidity. The urgency of the procedure and the method of pancreatic stump closure may influence postoperative morbidity.     

Laparoscopic distal pancreatectomy for lymphoepithelial cyst of the pancreas.

Lymphoepithelial cysts are rare pancreatic lesions. This case report describes the first excision of such a lesion by laparoscopic distal pancreatectomy which is a recognized procedure for treatment of cystic pancreatic neoplasms. Our patient underwent complete excision of the lesion and has enjoyed complete resolution of his symptoms. Laparoscopic distal pancreatectomy may be a suitable choice for first-line therapy for such lesions.     

不同闭合方式在降低胰体尾切除术后并发症的效果观察

目的探讨手工缝合和切割闭合器(Endo-GIA stapler)处理胰腺残端对胰体尾切除术后并发症的影响。方法回顾性分析南昌大学第一附属医院2014年1月至2018年8月收治的行胰体尾切除术88例病人的临床资料,根据不同闭合方式分为:手工缝合组24例、开腹闭合器组40例及腹腔镜闭合器组24例,比较三组病人在术中相关指标、术后恢复情况及并发症等方面的差异。结果三组病人在术中出血量、术后住院时间、病理良恶性、住院费用等方面差异均无统计学意义(均P>0.05),三组病人总并发症发生率及胰瘘发生率差异也无统计学意义(P>0.05)。结论切割闭合器与腹腔镜均不能降低胰体尾切除术后总并发症发生率,也不能降低胰瘘发生率。     

腹腔镜胰腺远端切除术临床应用

目的探讨腹腔镜胰腺远端切除术的安全性及可行性。方法 2005年9月至2009年6月,对36例胰腺体尾部肿物行腹腔镜胰腺远端切除术。术前34例诊断为胰腺体尾部良性肿物,2例不除外恶性,肿物中位直径5cm,平均(1.2～12)cm。结果所有手术均在全腹腔镜下完成。21例行保留脾脏的胰体尾切除(15例保留脾动静脉,6例未保留脾动静脉),14例行胰体尾加脾切除,1例既往行胰体尾及脾切除者行胰体部切除。手术中位时间248min,平均(118～400)min,中位出血量100ml,平均(50～800)ml,术后中位住院时间9d,平均(6～21)d。无胰漏或脾梗死发生,2例包裹性积液,均保守治疗治愈,1例引流管口感染。所有患者得到随访,中位随访时间25.5个月,平均(1～46)个月,均无复发。结论胰腺体尾部肿物行腹腔镜胰腺远端切除术安全、可行。     

Comparison of ultrasonically activated scalpel versus conventional division for the pancreas in distal pancreatectomy

Purpose: The goal of this study was to compare the benefits and complications of using an ultrasonically activated scalpel and conventional division of the pancreas in patients undergoing a distal pancreatectomy. Methods: A retrospective review was performed of all patients who underwent distal pancreatectomy at the Department of Surgery, Koshigaya Municipal Hospital. In the ultrasonically activated scalpel (US) group (n = 11), the pancreas was divided using coagulation shears. The stump of the pancreas was left open without parenchymal suturing. In the conventional surgical division (CV) group (n = 20), the pancreas was cut with a knife and the stump was oversewn with interrupted mattress sutures. The main pancreatic duct was ligated in all patients in both groups. The postoperative courses in the two groups were then compared in terms of postoperative serum amylase levels and the incidence of pancreatic fistulas. Results: The postoperative serum amylase levels were significantly lower in the US group than in the CV group (P < 0.01 on the day of operation). The incidence of pancreatic fistulas was also significantly lower in the US group (0%) than in the CV group (30%) (P = 0.04). Conclusions: The use of the ultrasonically activated scalpel was found to reduce the incidence of pancreatic fistula in distal pancreatectomy. Furthermore, the use of this device without any clamping or parenchymal suturing may reduce the damage to the remnant pancreas. Received: December 22, 2000 / Accepted: March 9, 2001     

Clinical outcomes compared between laparoscopic and open distal pancreatectomy

Background Laparoscopic surgery for pancreatic disease has gained increasing popularity. A laparoscopic distal pancreatectomy is technically simple and has been adopted as the preferred method in many centers. However, there is limited information on the outcomes of the laparoscopic surgery compared with open surgery. Therefore, this study aimed to investigate the clinical outcomes of laparoscopic distal pancreatectomy and to evaluate its efficacy compared with open distal pancreatectomy. Methods From February 1995 to March 2006, 31 patients underwent laparoscopic distal pancreatectomy, and 167 patients underwent open distal pancreatectomy at Seoul National University Hospital and Bundang Seoul National University Hospital. A case–control design was used with 2:1 matching to compare laparoscopic surgery with open surgery. Among 167 patients who underwent open distal pancreatectomy, 62 patients whose age, gender, and pathology were similar to those of patients who underwent laparoscopic surgery were selected for this study. The operation time, intraoperative transfusion requirements, duration of postoperative hospitalization, complications, mortality, recurrence, and hospital charges were analyzed. Results There were no significant differences in operation time, rate of intraoperative transfusions, complications, recurrence, or mortality between the two groups. Laparoscopic distal pancreatectomy was associated with a statistically significant shorter hospital stay (11.5 days vs 13.5 days; p = 0.049), but with more expensive hospital charges than open distal pancreatectomy (p < 0.01). Conclusion Laparoscopic distal pancreatectomy is a clinically safe and effective procedure for benign and borderline pancreatic tumors.