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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

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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]. 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]. 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]
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