切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (04) : 332 -335. doi: 10.3877/cma.j.issn.1674-3946.2019.04.003

所属专题: 述评/论坛 总编推荐 文献

专家论坛

腹腔镜保留脾脏胰体尾切除术的关键技术
杨尹默1,(), 高红桥1, 庄岩1, 田孝东1, 马永簌1   
  1. 1. 100031 北京,北京大学第一医院普外科
  • 收稿日期:2019-01-29 出版日期:2019-08-26
  • 通信作者: 杨尹默

Strategies and Technical Aspects of Laparoscopic Splenic-preserving Distal Pancreatectomy

Yinmo Yang1,(), Hongqiao Gao1, Yan Zhuang1, Xiaodong Tian1, Yongsu Ma1   

  1. 1. Department of General Surgery, the First Hospital of Peking University, Beijing 100031, China
  • Received:2019-01-29 Published:2019-08-26
  • Corresponding author: Yinmo Yang
  • About author:
    Corresponding author: Yang Yinmo, Email:
  • Supported by:
    National Natural Science Fundation of China(81672353, 81172184 and 30972879)
引用本文:

杨尹默, 高红桥, 庄岩, 田孝东, 马永簌. 腹腔镜保留脾脏胰体尾切除术的关键技术[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(04): 332-335.

Yinmo Yang, Hongqiao Gao, Yan Zhuang, Xiaodong Tian, Yongsu Ma. Strategies and Technical Aspects of Laparoscopic Splenic-preserving Distal Pancreatectomy[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(04): 332-335.

腹腔镜保留脾脏胰体尾切除术适用于胰体尾部良性或低度恶性病变,避免了脾切除术后近、远期并发症,手术方式包括保留脾动静脉的Kimura手术和切除脾动静脉主干、保留胃网膜左血管等侧枝循环的Warshaw手术。腹腔镜下Kimura手术视野清晰,安全可行,术后并发症发生率低,应为保脾胰体尾切除手术的首选。术前检查或术中探查可疑为浸润性恶性病变或病灶与脾血管、脾门关系密切者,应果断放弃保脾术式,改行胰体尾联合脾切除术。

For the potential long- and short-term complications associated with splenectomy, laparoscopic spleen-preserving distal pancreatectomy(Lap SPDP) is a feasible and comparably safe approach for the surgical treatment of benign or low-grade malignant tumors in the body and tail of the pancreas. Lap SPDP could be accomplished by using either the Kimura’s or the Warshaw technique, In Kimura’s technique, the integrity of both the splenic artery and vein are preserved, while in the Warshaw’s technique, main trunk of splenic artery and vein are ligated and dissected with preservation of left gastroepiploic artery. Laparoscopic Kimura’s procedure coulf be performed safely by experienced surgeon, with low incidence of splenic necrosis or abscess formation. However, in case of close adhesion of tumour with vessels or splenic hilar, combined splenectomy should be performed in time.

图1 分离胰后间隙显露脾动静脉[SV:脾静脉;SA:脾动脉]
图2 脾动脉根部水平骨骼化[SV:脾静脉;SA:脾动脉]
图3 Endo-GIA切断缝闭胰腺颈部[SV:脾静脉;Pancreas:胰腺]
图4~5 离断分离胰腺组织与脾静脉之间粘连,夹闭切断脾血管与胰腺之间小分支[SV:脾静脉;SA:脾动脉;Pancreas:胰腺]
图6 完整保留脾动、静脉,移除标本后可见脾下极缺血[SV:脾静脉]
[1]
庄岩,田孝东,高红桥,等.腹腔镜胰十二指肠切除术的难点与争议[J/CD].中华普外科手术学杂志(电子版),2018,12(4):271-274.
[2]
戴梦华.腹腔镜下半旋转胰头动脉优先入路十二指肠切除术的临床意义[J/CD].中华普外科手术学杂志(电子版),2018,12(4):275-278.
[3]
李冠群,陈华,孙备.腹腔镜胰体尾切除术的意义与评价[J/CD].中华普外科手术学杂志(电子版),2018,12(4):283-286.
[4]
Vijan SS, Ahmed KA, Harmsen WS, et al.Laparoscopic vs open distal pancreatectomy: a single-institution comparative study[J].Arch Surg,2010,145(7):616-621.
[5]
Xourafas D, Tavakkoli A, Clancy TE, et al.Distal Pancreatic Resection for Neuroendocrine Tumors: Is Laparoscopic Really Better than Open?[J].J Gastrointest Surg,2015,19(5):831-840.
[6]
Sahakyan MA, Kazaryan AM, Rawashdeh M, et al.Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients[J]. Surg Endosc,2016,30(8):3409-3418.
[7]
Tsiouris A, Cogan CM, Velanovich V.Distal pancreatectomy with or without splenectomy: comparison of postoperative outcomes and surrogates of splenic function[J]. HPB(Oxford), 2011,13(10):738-744.
[8]
Kristinsson SY, Gridley G, Hoover RN, et al. Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up[J]. Haematologica,2014, 99(2):392-398.
[9]
Sun LM, Chen HJ, Jeng LB, et al. Splenectomy and increased subsequent cancer risk: a nationwide populationbased cohort study[J].Am J Surg,2015,210(2):243-251.
[10]
Kimura W, Inoue T, Futakawa N, et al.Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein[J]. Surgery,1996,120(5):885-890.
[11]
Warshaw AL.Conservation of the spleen with distal pancreatectomy[J].Arch Surg,1988,123(5):550-553.
[12]
Kim H, Song KB, Hwang DW, et al.A single-center experience with the laparoscopic Warshaw technique in 122 consecutive patients[J].Surg Endosc, 2016,30(9):4057-4064.
[13]
Ferrone CR, Konstantinidis IT, Sahani DV, et al.Twenty-three years of the Warshaw operation for distal pancreatectomy with preservation of the spleen[J]. Ann Surg,2011,253(6):1136-1139.
[14]
Li BQ, Qiao YX, Li J, et al.Preservation or Ligation of Splenic Vessels During Spleen-Preserving Distal Pancreatectomy: A Meta-Analysis[J]. J Invest Surg,2018,11:1-16.
[1] 王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 吴鹏, 许维, 王壮, 郑世海, 宋劲松. 隧道法行腹腔镜下脾切除术的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(03): 319-322.
[4] 陈亚峰, 李江斌, 王栋, 臧莉, 鲁建国, 董瑞. 腹腔镜脾切除术在巨脾脾动脉栓塞后远期治疗中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(05): 571-574.
[5] 李海风, 战俊, 滕世岗, 尹鹏, 刘忠诚. 改良套扎法在腹腔镜完全腹膜外疝修补术中关闭腹膜破裂的临床应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 192-196.
[6] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[7] 卓文锋, 曾桂芳, 杨思加, 赵家立, 邹宝嘉, 白子锐, 林恩, 李坚. 腹腔镜巨脾切除术:逐步打破的手术壁垒[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 783-788.
[8] 邢颖, 程石. 巨脾外科治疗现状与介入治疗序贯手术策略[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 253-258.
[9] 廖艳, 成伟. 腹腔镜技术在胰腺癌中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 259-264.
[10] 张宇, 余灵祥, 赵亮, 张宁, 赵德希, 刁广浩, 杨木易, 刘佳, 李鹏, 任辉. 利伐沙班在脾切除联合贲门周围血管离断术后门静脉血栓预防中的疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 195-199.
[11] 苏日顺, 卢逸, 庄宝鼎, 张译, 李彦杰, 徐见亮. 肝硬化脾亢脾切除术后门静脉血栓形成影响因素[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 39-44.
[12] 许英晨, 张红, 付建柱, 张立军, 计嘉军. 脾脉管瘤合并脾囊肿一例报告[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 93-95.
[13] 张其坤, 商福超, 李琪, 栗光明, 王孟龙. 联合脾切除对肝癌合并门静脉高压症患者根治性切除术后的生存获益分析[J/OL]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 613-618.
[14] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J/OL]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[15] 胡小靖, 张华. 妊娠期卵巢囊肿蒂扭转的诊断与治疗[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 197-201.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?