保留脾脏的远端胰腺切除术后脾梗死的临床研究

摘要

目的 对比Kimura法及Warshaw法保留脾脏的远端胰腺切除术后脾梗死的发生情况及预后.方法 回顾性分析本治疗团队2007年1月至2013年12月181例行保留脾脏的远端胰腺切除术患者临床资料,其中Kimura法146例,Warshaw法35例.比较两种手术安全性及并发症差异并对比分析脾梗死情况.结果 Kimura法和Warshaw法在手术时间、术中出血量等组间差异均无统计学意义(P＞0.05).术后3天CT检查Kimura法脾梗死发生率为15.1％ (22/146),Warshaw法术后60.0％ (21/35)发生脾梗死,两组均在术后12个月内恢复正常.两组脾梗死的恢复时间分别是:(3.2±3.0)个月(Kimura法)和(4.8±3.3)个月(Warshaw法).结论 Kimura法和Warshaw法术后都存在脾梗死,但Kimura法术后发生率明显低于Warshaw法.保留脾脏的远端胰腺切除术应首选Kimura法.%Objective To compare splenic infarction incidence and clinical outcome of spleen-preserving distal pancreatectomy (SPDP) with splenic vessel preservation (SVP,Kimura procedure) or splenic vessel resection (SVR,Warshaw procedure).Methods We retrospectively reviewed clinical data of 181 patients who underwent SPDP for benign and low-grade malignant tumors occurred in pancreatic body and cauda between January 2007 and December 2013.Cases were divided into SVP (n =146) and SVR (n =35) groups.Safety and postoperative complications were compared to evaluate splenic infarction between the two groups.Results There were no significant differences in operation duration,intraoperative blood loss between the two groups (P ＞ 0.05).With CT study performed 3 days after operation,splenic infarction incidence was 15.1％ (22/146) in SVP group and 60.0％ (21/35) in SVR group,all the patients from two groups recovered within 12 months after operation,which were (3.2 ±3.0) months and (4.8 ±3.3) months in SVP and SVR groups,respectively.Conclusions Splenic infarction is the main complication resulted from SPDP with SVP and SVR.Nevertheless,the incidence of postoperative splenic infarction is significantly lower in SVP than SVR.Spleen-preserving distal pancreatectomy with splenic vessel preservation is preferred.