CAJ | 학술논문

目的探讨腹腔镜胰体尾联合脾切除术治疗胰体尾癌的临床疗效.方法回顾性分析2009年6月至2014年12月广州医科大学附属第三医院收治的37例胰体尾癌患者的临床资料.患者在全身麻醉下行腹腔镜胰体尾联合脾切除术.记录患者手术时间、术中出血量、术后并发症、术后拔除引流管时间、术后住院时间及术后病理学检查结果.采用门诊和电话方式进行随访,随访时间截至2015年5月.结果 37例患者均顺利完成腹腔镜胰体尾联合脾切除术,无一例中转开腹,无围术期死亡.其中19例患者因肿瘤包裹脾动、静脉,夹闭或离断脾动、静脉后脾脏大部分缺血而行脾切除术;11例患者因肿瘤累及脾门,粘连致密,分界不清,保脾困难而行脾切除术;7例患者因合并脾脏囊实性占位性病变而行脾切除术.手术时间为(232±42) min,术中出血量为(330±160) mL.4例患者术后发生胰液漏,患者无明显不适,带引流管出院,2周后返院拔除.其余33例患者术后拔除引流管时间为(5.0±2.0)d.全组患者术后平均住院时间为7.5 d(5.0～10.0 d).术后病理学检查结果:全组患者切缘均为阴性;中、低度恶性导管内乳头状黏液瘤12例,黏液性囊腺癌9例,中、低度恶性实性假乳头状瘤7例,导管腺癌4例,胰腺神经内分泌癌3例,腺泡细胞癌2例;淋巴结检出数目为(9±3)枚.37例患者均获得术后随访,中位随访时间为9个月(3～12个月).所有患者术后PLT有不同程度升高,21例患者PLT＞ 500×109/L,口服阿司匹林和(或)氯吡格雷后降至正常.随访期间,无患者肿瘤复发.结论腹腔镜胰体尾联合脾切除术治疗胰体尾癌安全、可行.
목적 탐토복강경이체미연합비절제술치료이체미암적림상료효.방법 회고성분석2009년6월지2014년12월엄주의과대학부속제삼의원수치적37례이체미암환자적림상자료.환자재전신마취하행복강경이체미연합비절제술.기록환자수술시간、술중출혈량、술후병발증、술후발제인류관시간、술후주원시간급술후병이학검사결과.채용문진화전화방식진행수방,수방시간절지2015년5월.결과 37례환자균순리완성복강경이체미연합비절제술,무일례중전개복,무위술기사망.기중19례환자인종류포과비동、정맥,협폐혹리단비동、정맥후비장대부분결혈이행비절제술;11례환자인종류루급비문,점련치밀,분계불청,보비곤난이행비절제술;7례환자인합병비장낭실성점위성병변이행비절제술.수술시간위(232±42) min,술중출혈량위(330±160) mL.4례환자술후발생이액루,환자무명현불괄,대인류관출원,2주후반원발제.기여33례환자술후발제인류관시간위(5.0±2.0)d.전조환자술후평균주원시간위7.5 d(5.0～10.0 d).술후병이학검사결과:전조환자절연균위음성;중、저도악성도관내유두상점액류12례,점액성낭선암9례,중、저도악성실성가유두상류7례,도관선암4례,이선신경내분비암3례,선포세포암2례;림파결검출수목위(9±3)매.37례환자균획득술후수방,중위수방시간위9개월(3～12개월).소유환자술후PLT유불동정도승고,21례환자PLT＞ 500×109/L,구복아사필림화(혹)록필격뢰후강지정상.수방기간,무환자종류복발.결론 복강경이체미연합비절제술치료이체미암안전、가행.
Objective To explore the clinical efficacies of laparoscopic distal pancreatectomy (LDP) with laparoscopic splenectomy (LS) for the treatment of malignant tumors in the body and tail of pancreas.Methods The clinical data of 37 patients with malignant tumors in the body and tail of pancreas who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from June 2009 to December 2014 were retrospectively analyzed.LDP with LS was performed on all the patients under general anesthesia.The operation time,volume of intraoperative blood loss,postoperative complications,removal time of postoperative drainage tube,duration of hospital stay and results of pathological examinations were recorded.All the patients were followed up via outpatient examination and telephone interview up to May 2015.Results Thirty-seven patients received successful surgery without conversion to open surgery and perioperative death.Of 37 patients,19 received splenectomy due to splenic artery and vein surrounded by masses of pancreatic body and tail,splenic ischemia after clamping or amputating of splenic artery and vein;11 received splenectomy due to splenic hilum invasion,dense adhesions,unclear boundary and difficulty in preserving spleen;7 received splenectomy due to splenic cystic occupying lesion.The operation time,volume of intraoperative blood loss and removal time of drainage tube were (232 ± 42) minutes,(330 ± 160)mL and (5.0 ± 2.0)days,respectively.Four patients were complicated with pancreatic leakage without obvious discomfort and discharged from hospital with a placement of drainage tube,and then drainage tubes were removed after 2 weeks.The mean duration of postoperative hospital stay was 7.5 days (range,5.0-10.0 days).The results of pathological examination showed that resection margin was negative,moderate and low malignant intraductal papillary mucinous neoplasm (IPMN) was detected in 12 patients,mucinous cystic carcinoma in 9 patients,moderate and low malignant solid pesudopapillary neoplasm (SPN) in 7 patients,pancreatic ductal adenocarcinoma in 4 patients,pancreatic neuroendocrine cancer in 3 patients and acinic cell carcinoma in 2 patients.The number of detecting lymph node was (9 ± 3).All the patients were followed up for a mean time of 9 months (range,3-12 months) without recurrence of tumors.The platelet (PLT) of 37 patients was different levels of increasing.Of 21 patients with PLT ＞ 500 × 109/L,PLT was returned to normal range after aspirin and/ or clopidogrel were taken orally.Conclusion LDP with LS is safe and feasible for malignant tumors in the body and tail of pancreas.