CAJ | 학술논문

腹腔镜下胰腺体尾部切除术，适应证主要为胰腺体尾部的良性肿瘤或低度恶性肿瘤，对于胰腺体尾部恶性肿瘤，仍建议联合脾脏切除术。根据胰腺体尾部及肿瘤与脾血管的位置关系，术中最终决定是否保留脾脏及脾血管情况。患者一般取平卧位，采用四孔法，先探查，明确有无腹腔转移及局部严重侵犯情况。打开胃结肠韧带，显露胰腺体尾部，对肿瘤进行定位。先后游离胰腺下缘及上缘，并打通胰腺后方置入尿管牵拉胰腺。利用直线切割闭合器（ EC-60），经胰腺后方将胰腺离断，将胰腺断端向尾部翻起，离断胰腺后方组织，完整游离后切除胰体尾，并结扎脾血管至胰腺的交通支。
복강경하이선체미부절제술，괄응증주요위이선체미부적량성종류혹저도악성종류，대우이선체미부악성종류，잉건의연합비장절제술。근거이선체미부급종류여비혈관적위치관계，술중최종결정시부보류비장급비혈관정황。환자일반취평와위，채용사공법，선탐사，명학유무복강전이급국부엄중침범정황。타개위결장인대，현로이선체미부，대종류진행정위。선후유리이선하연급상연，병타통이선후방치입뇨관견랍이선。이용직선절할폐합기（ EC-60），경이선후방장이선리단，장이선단단향미부번기，리단이선후방조직，완정유리후절제이체미，병결찰비혈관지이선적교통지。
The indications of laparoscopic distal pancreatectomy were mainly restricted in treating benign tumors or low grade malignant tumors in pancreatic body or tail.For malignant tumors in this area, laparoscopic distal pancreatectomy combined with splenectomy was still recommended.The final decision of whether to preserve splenic vessels or spleen should be made intraoperatively according to the positional relationship between the tumor, the splenic vessels and the pancreatic body and tail.Generally, the patient was laid in supine position, and 4-trocars method was employed.The informations about abdominal metastasis or local serious invasion were presented by laparoscopic exploration.The gastrocolic ligament were dissected to expose pancreatic body and tail , and tumor was located.The upper and lower border of the pancreas were dissected, and the posterior space were canalized to place a urinary catheter which was used to pull the pancreas .The linear cutter staplers (EC 60) were used to cut the pancreas through the posterior canal , and the left part of pancreas were lifted toward pancreatic tail to dissect the posterior tissue of pancreas , and the pancreatic body and tail were resected after complete dissection.The communicating branches of splenic vessels and pancreas were ligated .