腹腔镜保留脾脏血管的胰腺远端切除术的下内侧入路

Kee Tae Park, Joo Dong Kim
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引用次数: 0

摘要

背景和目的:在腹腔镜保脾远端胰腺切除术(LSPDP)中完全保留脾脏血管是最理想的。然而,由于脾脏血管通常深埋于胰腺实质内,因此保留脾脏血管仍具有挑战性且耗时较长。在此,我们介绍了腹腔镜下保留脾脏血管远端胰腺切除术(lap-SVPDP)的下内侧方法,并对其安全性和可行性进行了评估:43名患者在本院接受了由一名外科医生实施的腹腔镜脾血管保留远端胰腺切除术:26名(60.5%)患者采用腹腔镜脾血管保留远端胰腺切除术(lap-SVPDP),17名患者采用腹腔镜Warshaw技术(lap-WT)。我们比较了两组手术的结果。没有接受腹腔镜SVPDP手术的患者需要转为开腹手术或腹腔镜WT手术:结果:两组患者的大部分术前特征和术后结果均无差异;尽管腹腔镜-SVPDP技术更为复杂,但手术时间和术中失血量均无差异。腹腔-WT组的平均肿瘤大小大于腹腔-SVPDP组(P = .001)。腹腔镜SVPDP组的脾静脉通畅率不低于由同一外科医生治疗的开腹SVPDP组:结论:下腹-内侧入路腹腔镜脾静脉置换术是一种安全可行的腹腔镜脾静脉置换术,既不会增加失血量,也不会延长手术时间。
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Inferior-Medial Approach to Laparoscopic Splenic Vessel-Preserving Distal Pancreatectomy.

Background and objectives: Complete preservation of the splenic vessels is ideal during laparoscopic spleen-preserving distal pancreatectomy (LSPDP). However, this remains challenging and time-consuming because the vessels are often deeply embedded in the pancreatic parenchyma. Herein, we introduce our inferior-medial approach to laparoscopic splenic vessel-preserving distal pancreatectomy (lap-SVPDP) and evaluate its safety and feasibility.

Methods: Forty-three patients underwent LSPDP performed by a single surgeon at our institution: 26 (60.5%) lap-SVPDPs with an inferior-medial approach and 17 with the laparoscopic Warshaw technique (lap-WT). We compared the outcomes of the 2 groups. No patient undergoing lap-SVPDP required conversion to laparotomy or lap-WT.

Results: Most preoperative characteristics and postoperative outcomes did not differ between the 2 groups; neither the operation time nor the intraoperative blood loss differed despite the greater technical complexity of lap-SVPDP. The mean tumor size was greater in the lap-WT than the lap-SVPDP group (P =.001). The splenic vein patency rate of the lap-SVPDP group was not inferior to that of the open SVPDP group treated by the same surgeon.

Conclusion: Inferior-medial approach lap-SVPDP could be a safe and feasible technique for lap-SVPDP; neither blood loss nor operation time is increased.

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来源期刊
CiteScore
2.40
自引率
0.00%
发文量
69
审稿时长
4-8 weeks
期刊介绍: JSLS, Journal of the Society of Laparoscopic & Robotic Surgeons publishes original scientific articles on basic science and technical topics in all the fields involved with laparoscopic, robotic, and minimally invasive surgery. CRSLS, MIS Case Reports from SLS is dedicated to the publication of Case Reports in the field of minimally invasive surgery. The journals seek to advance our understandings and practice of minimally invasive, image-guided surgery by providing a forum for all relevant disciplines and by promoting the exchange of information and ideas across specialties.
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