保留脾脏胰体尾切除术的临床探讨
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陈启龙 E-mail:chenqilong651003@sohu.com

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Clinical study on spleen-preserving distal pancreatectomy
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    摘要:

    目的:探讨保留脾脏胰体尾切除术的可行性和安全性。
    方法:总结2006年2月—2010年8月16例胰体尾部良性和交界性病变实行了保留脾脏的胰体尾切除术的临床资料,其中15例为保留脾脏血管胰体尾切除,1例为切断脾血管保留脾脏胰体尾切除。
    结果:术后发生胰瘘9例,切口感染1例,腹腔出血3例(其中1例为胰瘘后发生出血),胸腔积液2例。9例胰瘘者,8例经非手术治疗,3~7周痊愈,1例并发出血后行数字减影脾动脉栓塞止血,第17周痊愈。另2例腹腔出血者,1例经非手术治疗治愈,1例二次手术,见脾静脉分支出血,结扎止血。全组无死亡病例。
    结论:胰体尾部良性和交界性肿瘤,可首先选择保留脾脏的胰体尾切除术,手术安全,疗效好。

    Abstract:

    Objective:To evaluate the feasibility and safety of spleen-preserving distal pancreatectomy.
    Methods:From February 2006 to Agust 2010, a total of 16 patients with benign or junctional tumor in the body and tail of pancreas underwent spleen-preserving distal pancreatectomy (SPDP) at our center. Of the patients, 15 cases underwent SPDP with conservation of splenic vessels and one case with dissection of splenic vessels.
    Results: Postoperative complications included 9 cases of pancreatic fistula, one case of wound infection, 3 cases of abdominal bleeding (one case of bleeding due to pancreatic fistula), and 2 cases of pleural effussion. Of the 9 patients with pancreatic fistula, 8 of them healed within 3 to 7 weeks by nonsurgical treatment, while one case complicated with hemorrhage underwent digital subtraction angiography and splenic arterial embolization to stop bleeding, and recovered at the 17th week postoperatively. In another 2 cases of intraabdominal bleeding, one was controlled with nonsurgical treatment, the an other one underwent reoperation and ligation of a branch of the splenic vein that was bleeding. There was no mortality in this group.
    Conclusions:SPDP can be used as first choice for patients with benign or junctional tumor of distal pancreas, and is a safe procedure with satisfactory results.

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林海| 王护国| 陈启龙| 王喜艳| 韩玮| 何铁英| 程坤.保留脾脏胰体尾切除术的临床探讨[J].中国普通外科杂志,2011,20(9):913-916.
DOI:10.7659/j. issn.1005-6947.2011.09.003

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  • 收稿日期:2010-11-24
  • 最后修改日期:2011-07-07
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  • 在线发布日期: 2011-09-15