CAJ | 학술논문

目的胰体尾良性肿瘤切除手术需要尽量保脾.本研究旨在评估机器人保脾行胰体尾切除手术的安全性与可行性.方法分析、总结解放军总医院2009年6月至2012年3月行机器人切除胰体尾良性肿瘤或交界性肿瘤7例病例资料.结果 7例患者均成功施行机器人胰体尾切除术,其中6例保脾,另1例因胰尾脾门粘连致密而行联合脾脏切除.6例保脾成功患者中,尚有1例行联合右肾上腺肿瘤切除术,1例胆囊切除术.无二次手术.平均手术时间368 min,出血200 ml.术后出血1例,给予止血药物后治愈,未再次手术.根据国际胰瘘研究小组定义,A级胰瘘1例.术后平均住院8.7d.无其他并发症发生.结论机器人胰体尾切除手术安全可行.因其三维的视觉、稳定的操作,故在保脾方式上多采用Kimura法.该法能最大程度地保留脾脏完整的供血系统,减少术后区域性门脉高压发生的可能性.
목적 이체미량성종류절제수술수요진량보비.본연구지재평고궤기인보비행이체미절제수술적안전성여가행성.방법 분석、총결해방군총의원2009년6월지2012년3월행궤기인절제이체미량성종류혹교계성종류7례병례자료.결과 7례환자균성공시행궤기인이체미절제술,기중6례보비,령1례인이미비문점련치밀이행연합비장절제.6례보비성공환자중,상유1례행연합우신상선종류절제술,1례담낭절제술.무이차수술.평균수술시간368 min,출혈200 ml.술후출혈1례,급여지혈약물후치유,미재차수술.근거국제이루연구소조정의,A급이루1례.술후평균주원8.7d.무기타병발증발생.결론 궤기인이체미절제수술안전가행.인기삼유적시각、은정적조작,고재보비방식상다채용Kimura법.해법능최대정도지보류비장완정적공혈계통,감소술후구역성문맥고압발생적가능성.
Objective For benign or tumor of borderline malignancy in the distal pancreas,a spleen-preserving distal pancreatectomy can be carried out.This study aimed to assess the safety and feasibility of this operation.Methods Between June 2009 and March 2012,7 patients underwent laparoscopic distal pancreatectomy assisted by the da Vinci Robotic System (RDP) for benign or pancreatic tumor with borderline malignancy.The clinical data were analyzed.Results Robotic-assisted spleen-preserving laparoscopic distal pancreatectomy was successfully carried out in 6 patients,with robotic assisted splenectomy and distal pancreatectomy on the remaining patient.Among them,to the 6 patients with distal pancreatectomy,one patient received right adrenal tumor resection and another patient received cholecystectomy.The average operation time was 368 minutes,and the blood loss was 200 ml.One patient developed postoperative bleeding,and was treated conservatively with hemostatic drugs (grade Ⅱ).There was no conversion to laparotomy.According to the international pancreatic fistula research team's classification of postoperative pancreatic fistula,1 patients were diagnosed to have pancreatic fistula (grade A).The mean postoperative hospital stay was 8.7 days.There were no other complications.Conclusions Robotic-assisted spleen-preserving laparoscopic distal pancreatectomy was safe and feasible.The Kimura operation was used in spleen-preserving operations because its 3D visual field and stability in control helped to preserve splenic blood supply and reduced the chance of postoperative regional portal hypertension.