CAJ | 학술논문

目的总结腹腔镜胰体尾切除术(LDP)的临床应用经验.方法回顾性分析2003年11月至2010年12月行LDP的68例患者临床资料.其中男性23例,女性45例；年龄17 ～ 77岁,中位年龄47岁.对LDP的安全性、可行性及手术技术操作进行总结分析.结果患者中除2例中转开腹外,余66例在腹腔镜下顺利完成手术.其中48例LDP联合脾脏切除术中10例合并多脏器切除,18例保留脾脏LDP中4例合并多脏器切除.平均手术时间.(209±58) min,平均术中出血量(191±123)ml,平均术后下床活动时间(1.2±0.6)d,首次进食流质时间(2.8±1.1)d,术后住院时间(8±4)d.术后发生胰漏8例(12.1％)；4例延长拔管时间、充分引流,抗感染治疗后痊愈,3例行CT引导下腹腔积液穿刺引流后痊愈(1例同时合并脾梗死),1例因胰漏致腹腔感染行二次手术后痊愈.其余术后并发症包括腹腔感染1例,肺部感染2例,乳糜漏1例,总体并发症发生率为18.1％；无围手术期死亡.术后病理结果显示肿块大小1.5～15.0 cm,平均(6±3)cm；切除胰腺长度6.5～10.0cm,平均(7 ±2)cm.病理类型包括胰腺良性病变29例,交界性或低度恶性病变27例,恶性病变12例.结论对于具有丰富腹腔镜手术及开腹胰体尾手术经验的术者,LDP治疗胰腺体尾部占位性病变安全可行.
목적 총결복강경이체미절제술(LDP)적림상응용경험.방법 회고성분석2003년11월지2010년12월행LDP적68례환자림상자료.기중남성23례,녀성45례；년령17 ～ 77세,중위년령47세.대LDP적안전성、가행성급수술기술조작진행총결분석.결과 환자중제2례중전개복외,여66례재복강경하순리완성수술.기중48례LDP연합비장절제술중10례합병다장기절제,18례보류비장LDP중4례합병다장기절제.평균수술시간.(209±58) min,평균술중출혈량(191±123)ml,평균술후하상활동시간(1.2±0.6)d,수차진식류질시간(2.8±1.1)d,술후주원시간(8±4)d.술후발생이루8례(12.1％)；4례연장발관시간、충분인류,항감염치료후전유,3례행CT인도하복강적액천자인류후전유(1례동시합병비경사),1례인이루치복강감염행이차수술후전유.기여술후병발증포괄복강감염1례,폐부감염2례,유미루1례,총체병발증발생솔위18.1％；무위수술기사망.술후병리결과현시종괴대소1.5～15.0 cm,평균(6±3)cm；절제이선장도6.5～10.0cm,평균(7 ±2)cm.병리류형포괄이선량성병변29례,교계성혹저도악성병변27례,악성병변12례.결론 대우구유봉부복강경수술급개복이체미수술경험적술자,LDP치료이선체미부점위성병변안전가행.
Objective To evaluate the feasibility and efficacy of laparoscopic distal pancreatectomy.Methods Totally 68 patients (male 23,female 45) aged 17 to 77 years,with distal pancreatic lesions,underwent laparoscopic distal pancreatectomy from November 2003 to December 2010.The clinical data were collected. Safety, feasibility and crucial technique manipulation were analyzed retrospectively.Results All 68 operations were successful with two cases conversion to open,including 48 casesconbined with splenectomy,and 18 cases with preservation of spleen.Fourteen cases received with combination resection of multi-organs,including 4 cases with cholecystectomy, 1 case resection of right adrenal adenoma and cholecystectomy,1 case with myomectomy and left ovarian teratomectomy; 1 case with right ovarian teratomectomy, 1 case with resection of left adrenal adenoma, 1 case with resection of both adrenal adenoma,1 case with resection of liver metastasis,1 case with cbolecystectomy and resection of liver metastasis,1 case with resection of left adrenal adenoma and liver metastasis,1 case with resection of left adrenal adenoma and colon and spleen,1 case with biopsy of liver nodule. The mean operative time was (209 ±58) minutes,the mean intraoperative blood loss was (191 ± 123) ml,and the mean postoperative hospital stay was (8 ± 4) days. The rate of overall postoperative complications was 18.1％,including an 12.1％ rate of clinical pancreatic fistula. Only one case needed a reoperation, and there was no postoperative mortality. Conclusion Laparoscopic distal pancreatectomy with or without splenectomy is safe and feasible in the treatment of most distal pancreatic tumors.