目的

比较两种不同保脾胰体尾切除术治疗胰体尾肿瘤的疗效。

方法

回顾性分析2020年1月至2022年12月接受保脾胰体尾切除术的87例患者资料，根据术式不同分为Kimura组（n=44例）和Warshaw组（n=43例）。采用SPSS25.0软件分析数据，围手术期指标、免疫功能指标等计量资料以（±s）表示，行独立样本t检验；术后并发症发生情况、随访期间复发率、再次手术情况等计数资料行χ²检验。以P＜0.05为差异有统计学意义。

结果

Kimura组患者手术时间长于Warshaw组（P＜0.05），术中失血量、肛门通气时间比较，差异无统计学意义（P＞0.05）；Kimura组患者首次下床活动时间、引流管拔除时间、术后住院时间均短于Warshaw组（P＜0.05）；两组患者术后1d CD3⁺、CD4⁺、CD4⁺/CD8⁺较术前均降低，但Kimura组高于Warshaw组（P＜0.05）；Kimura组患者术后并发症发生率4.6%（2/44）低于Warshaw组20.9%（9/43）（P＜0.05）；随访期间，两组患者均未出现复发、再次手术情况。

结论

两种保脾胰体尾切除术治疗胰体尾肿瘤均可获得理想疗效，而相对于Warshaw术式，Kimura术式虽手术时间较长，但可避免术后免疫功能大幅下降，减少术后并发症发生，促进患者早期康复。

Objective

To compare the efficacy of two different spleen-preserving distal pancreatectomies in the treatment of tumors of the body and tail of the pancreas.

Methods

The data of 87 patients who underwent spleen-preserving distal pancreatectomy from January 2020 to December 2022 were retrospectively analyzed.According to different surgical methods，they were divided into the Kimura group （n=44 cases） and the Warshaw group （n=43 cases）.The SPSS25.0 software was used for data analysis.Measurement data such as perioperative indicators and immune function indicators were expressed as （±s），and the independent-sample t test was performed.Count data such as the occurrence of postoperative complications，recurrence rate during follow-up，and re-operation status were analyzed by the χ² test.A P value＜0.05 was considered statistically significant.

Results

The operation time of patients in the Kimura group was longer than that in the Warshaw group （P＜0.05）.There was no significant difference in intraoperative blood loss and the time of anal flatus between the two groups （P＞0.05）.The time of first getting out of bed，the time of drainage tube removal，and the postoperative hospital stay of patients in the Kimura group were all shorter than those in the Warshaw group （P＜0.05）.On the first day after surgery，the levels of CD3⁺，CD4⁺，and CD4⁺/CD8⁺ in both groups decreased compared with those before surgery，but the levels in the Kimura group were higher than those in the Warshaw group （P＜0.05）.The incidence of postoperative complications in the Kimura group was 4.6% （2/44），which was lower than 20.9% （9/43） in the Warshaw group （P＜0.05）.During the follow-up period，neither group had recurrence or re-operation.

Conclusion

Both spleen-preserving distal pancreatectomies can achieve ideal efficacy in the treatment of tumors of the body and tail of the pancreas.Compared with the Warshaw procedure，although the Kimura procedure has a longer operation time，it can avoid a significant decline in postoperative immune function，reduce the occurrence of postoperative complications，and promote the early recovery of patients.