腹腔镜下保留脾脏胰体尾切除术治疗胰腺囊实性肿瘤中青年患者的临床效果（附30例报告）

Laparoscopic spleen-preserving distal pancreantectomy in treatment of pancreatic solid-cystic tumor in young and middle-aged patients (30 cases)

摘要:

目的 探讨腹腔镜下保留脾脏胰体尾切除术治疗胰腺囊实性肿瘤中青年患者的可行性和安全性。方法 回顾性分析该院收治的30例胰腺囊实性肿瘤中青年患者的临床资料，均实施腹腔镜下保留脾脏胰体尾切除术，观察统计患者的手术时间、出血量、术后下床时间、术后肛门恢复排气时间、术后住院时间、术后并发症及处理方法、病理类型及随访结果。结果 30例患者均于腹腔镜下顺利完成手术，无中转开腹。其中，29例成功保留脾脏，1例术中联合脾脏切除。手术时间（200.5±20.5）min，出血量（220.4±30.5）mL，术后下床时间（1.5±0.5）d，术后肛门恢复排气时间（2.1±1.1）d，术后住院时间（6.5±1.5）d。术后5例出现胰漏，4例经保守治疗治愈，1例经穿刺引流治愈。术后病理报告显示，胰腺实性假乳头状瘤12例，黏液性囊腺瘤10例，浆液性囊腺瘤3例，神经内分泌肿瘤5例。术后平均随访1年，未见肿瘤复发和大范围脾脏梗死。结论 腹腔镜下保留脾脏胰体尾切除术需要由具备丰富腹腔镜操作技能的医师实施，用该方法治疗胰腺囊实性肿瘤中青年患者安全且高效，其具有创伤小、恢复快和并发症少等优点。

Abstract:

Objective To explore the feasibility and safety of laparoscopic spleen-preserving distal pancreantectomy in treatment of pancreatic solid-cystic tumor in young and middle-aged patients.Method 30 patients with pancreatic solid-cystic tumor received totally laparoscopic spleen-preserving distal pancreantectomy, the data on operative time, intraoperative bleeding, postoperative time to get out of bed, time of first flatus, postoperative hospital stay, complication, pathological type, and postoperative follow-up were collected and analyzed retrospectively.Result All the operations were carried out successfully with laparoscopic surgery, no conversion to open surgery. The operative time was (200.5 ± 20.5) min, the intraoperative blood loss was (220.4 ± 30.5) mL, the postoperative time to get out of bed was (1.5 ± 0.5) d, and the time of first flatus was (2.1 ± 1.1) d, the postoperative hospital stay was (6.5 ± 1.5) d. Pancreatic leakage occurred in 5 cases after operation, among of them, 4 cases were cured by conservative treatment and 1 case was cured by puncture and drainage. Postoperative pathology type included 12 cases of pancreatic solid pseudopapillary neoplasm, 10 cases of mucinous cystadenoma, 3 cases of serous cystadenoma, and 5 cases of neuroendocrine tumor. There was no tumor recurrence and large-scale splenic infarct in 1 year follow-up.Conclusion Laparoscopic spleen-preserving distal pancreantectomy was an efficacious, safe, and minimally invasive procedure in the treatment of pancreatic solid-cystic tumor in young and middle-aged patients.