腹腔镜胰体尾联合脾切除术治疗胰体尾癌的临床疗效

摘要

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.%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.