切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2017, Vol. 06 ›› Issue (01) : 24 -28. doi: 10.3877/cma.j.issn.2095-3232.2017.01.006

所属专题: 文献

临床研究

3D腹腔镜在保脾胰体尾切除术中的应用价值
段小辉1, 毛先海1,(), 周力学1, 杨建辉1, 田秉璋1, 蒋波1   
  1. 1. 410005 长沙,湖南省人民医院肝胆外科
  • 收稿日期:2016-10-20 出版日期:2017-02-10
  • 通信作者: 毛先海
  • 基金资助:
    湖南省卫生计生委科研基金项目(C2015-41); 湖南省科技计划重点研发项目(2015sk2050)

Application value of three-dimensional laparoscope in spleen-preserving distal pancreatectomy

Xiaohui Duan1, Xianhai Mao1,(), Lixue Zhou1, Jianhui Yang1, Bingzhang Tian1, Bo Jiang1   

  1. 1. Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Changsha 410005, China
  • Received:2016-10-20 Published:2017-02-10
  • Corresponding author: Xianhai Mao
  • About author:
    Corresponding author: Mao Xianhai, Email:
引用本文:

段小辉, 毛先海, 周力学, 杨建辉, 田秉璋, 蒋波. 3D腹腔镜在保脾胰体尾切除术中的应用价值[J]. 中华肝脏外科手术学电子杂志, 2017, 06(01): 24-28.

Xiaohui Duan, Xianhai Mao, Lixue Zhou, Jianhui Yang, Bingzhang Tian, Bo Jiang. Application value of three-dimensional laparoscope in spleen-preserving distal pancreatectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(01): 24-28.

目的

探讨3D腹腔镜在保脾胰体尾切除术中的应用价值,并总结其临床应用经验和手术技巧。

方法

回顾性分析2014年1月至2016年5月在湖南省人民医院行3D腹腔镜保脾胰体尾切除术的16例胰体尾占位性病变患者临床资料。其中男5例,女11例;年龄23~64岁,中位年龄43岁。患者均签署知情同意书,符合医学伦理学规定。本组患者均采用Kimura法完成保脾胰体尾切除术。术中在胰腺后方分离并保留脾动、静脉,切除胰体尾部。观察患者的术中及术后情况,并对患者进行随访。

结果

本组所有患者均成功实施3D腹腔镜保脾胰体尾切除术。手术时间中位数为216(150~285)min,术中出血量273(150~500)ml,术中无中转开腹。术后发生胰瘘2例,1例经保守治疗治愈,1例并发出血,经再手术后治愈。术后无死亡病例,术后住院时间11(5~29)d。术后病理学检查示:浆液性囊腺瘤5例,黏液性囊腺瘤4例,潴留性囊肿3例,实性假性乳头状肿瘤2例,功能性胰岛细胞瘤2例。术后随访时间9(1~28)个月,患者生活质量良好,未见复发。

结论

3D腹腔镜保脾胰体尾切除术治疗胰体尾部良性或交界性肿瘤有效、安全、可行,具有微创、术后并发症发生率低、术后恢复快等优点。

Objective

To investigate the application value of three-dimensional (3D) laparoscope in spleen-preserving distal pancreatectomy, and summarize the clinical experience and surgical skills.

Methods

Clinical data of 16 patients with space-occupying lesions at the body and tail of pancreas who underwent 3D laparoscopic spleen-preserving distal pancreatectomy in Hunan Provincial People's Hospital from January 2014 to May 2016 were retrospectively analyzed. There were 5 males and 11 females with the age ranging from 23 to 64 years old and the median of 43 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients underwent spleen-preserving distal pancreatectomy using Kimura's procedure. During the operation, the splenic artery and vein were isolated and preserved behind the pancreas, and the body and tail of pancreas were resected. Intraoperative and postoperative conditions were observed and all patients were followed up.

Results

All patients underwent 3D laparoscopic spleen-preserving distal pancreatectomy successfully. The median operation time was 216 (150-285) min. The intraoperative blood loss was 273 (150-500) ml. No conversion to open surgery was observed during the surgery. Two cases of pancreatic fistula were observed after surgery, 1 case was cured by conservative therapy, and the other case was complicated with bleeding and was cured by reoperation. No death was observed after surgery. The postoperative length of hospital stay was 11 (5-29) d. Postoperative pathological examination indicated that 5 cases presented with serous cystadenoma, 4 with mucinous cystadenoma, 3 with retention cysts, 2 with solid pseudopapuillary tumors and 2 with functional islet cell tumors. The postoperative follow-up time was 9 (1-28) months, the patients had a good living quality and no recurrence was observed.

Conclusions

The 3D laparoscopic spleen-preserving distal pancreatectomy is an efficacious, safe and feasible procedure for distal pancreatic benign or borderline tumors. It has the advantages of minimal invasion, low incidence of postoperative complications and fast postoperative recovery.

图1 3D腹腔镜保脾胰体尾切除术手术过程
[1]
Worhunsky DJ, Zak Y, Dua MM, et al. Laparoscopic spleen-preserving distal pancreatectomy: the technique must suit the lesion[J]. J Gastrointest Surg, 2014, 18(8): 1445-1451.
[2]
Panda N, Bansal NK, Narsimhan M, et al. Spleen-preserving versus spleen-sacrificing distal pancreatectomy in laparoscopy and open method-perioperative outcome analysis-14 years experience[J]. Indian J Surg, 2016, 78(2): 90-95.
[3]
Usta TA, Ozkaynak A, Kovalak E, et al. An assessment of the new generation three-dimensional high definition laparoscopic vision system on surgical skills: a randomized prospective study[J]. Surg Endosc, 2015, 29(8): 2305-2313.
[4]
Sørensen SM, Savran MM, Konge L, et al. Three-dimensional versus two-dimensional vision in laparoscopy: a systematic review[J]. Surg Endosc, 2016, 30(1): 11-23.
[5]
Guerra F, Pesi B, Fatucchi LM, et al. Splenic preservation during open and minimally-invasive distal pancreatectomy[J]. Surgery, 2015, 158(6):1743-1744.
[6]
Yan JF, Xu XW, Jin WW, et al. Laparoscopic spleen-preserving distal pancreatectomy for pancreatic neoplasms: a retrospective study[J]. World J Gastroenterol, 2014 , 20(38): 13966-13972.
[7]
D'Ambrosio G, Quaresima S, Balla A, et al. Spleen preserving laparoscopic distal pancreatectomy for treatment of pancreatic lesions[J]. Ann Ital Chir, 2015, 86(3): 273-278.
[8]
Ding X, Tan J, Qian J. Laparoscopic spleen-preserving distal pancreatectomy (LSPDP)[J]. Hepatogastroenterology, 2013, 60(123):605-610.
[9]
Topgül K, Yürüker SS, Koca B, et al. Spleen-preserving laparoscopic distal pancreatectomy: two cases and review of the technique[J]. Ulus Cerrahi Derg, 2013, 29(3): 139-143.
[10]
Chen JH, Huang KF, Li CH. Preservation of splenic vessels during laparoscopic spleen-preserving distal pancreatectomy via lateral approach[J]. Wideochir Inne Tech Maloinwazyjne, 2015, 10(3):382-388.
[11]
Ikeda T, Yoshiya S, Toshima T, et al. Laparoscopic distal pancreatectomy preserving the spleen and splenic vessels for benign and low-grade malignant pancreatic neoplasm[J]. Fukuoka Igaku Zasshi, 2013, 104(3):54-63.
[12]
Inoko K, Ebihara Y, Sakamoto K, et al. Strategic approach to the splenic artery in laparoscopic spleen-preserving distal pancreatectomy[J]. Surg Laparosc Endosc Percutan Tech, 2015, 25(4):e122-125.
[13]
Usta TA, Gundogdu EC. The role of three-dimensional high-definition laparoscopic surgery for gynaecology[J]. Curr Opin Obstet Gynecol, 2015, 27(4): 297-301.
[14]
Kyriazis I, Özsoy M, Kallidonis P, et al. Integrating three-dimensional vision in laparoscopy: the learning curve of an expert[J]. J Endourol, 2015, 29(6): 657-660.
[15]
Shi J, Xia J, Wei Y, et al. Three-dimensional virtual reality simulation of periarticular tumors using Dextroscope reconstruction and simulated surgery: a preliminary 10-case study[J]. Med Sci Monit, 2014(20):1043-1050.
[16]
Lv GY, Wang GY, Jiang C, et al. Laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessel conservation: a retrospective study of 20 cases[J]. Hepatogastroenterology, 2013, 60(127):1785-1788.
[17]
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.
[18]
Yu X, Li H, Jin C, et al. Splenic vessel preservation versus Warshaw's technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review[J]. Langenbecks Arch Surg, 2015,400(2):183-191.
[19]
Jean-Philippe Adam, Alexandre Jacquin, Christophe Laurent, et al. Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique[J]. JAMA Surg, 2013, 148(3):246-252.
[20]
Matsushima H, Kuroki T, Adachi T, et al. Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation: the role of the Warshaw procedure[J]. Pancreatology, 2014, 14(6):530-535.
[21]
Misawa T, Ito R, Futagawa Y, et al. Single-incision laparoscopic distal pancreatectomy with or without splenic preservation: how we do it[J]. Asian J Endosc Surg, 2012, 5(4):195-199.
[1] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[2] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[3] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[4] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[5] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[6] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[7] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[8] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[9] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[10] 唐健雄, 李绍杰. 不断推进中国腹腔镜疝手术规范化[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 591-594.
[11] 田文, 杨晓冬. 腹腔镜腹股沟疝修补术式选择及注意事项[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 595-597.
[12] 李涛, 陈纲, 李世拥. 腹腔镜下右侧腹股沟斜疝修补术(TAPP)[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 598-598.
[13] 易明超, 汪鑫, 向涵, 苏怀东, 张伟. 一种T型记忆金属线在经脐单孔腹腔镜胆囊切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 599-599.
[14] 马涛, 叶春伟, 刘滔, 彭文希, 李志鹏. 腹腔镜与开放性离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 605-610.
[15] 刘成, 赖聪, 黄健, 王建辰, 罗茜芸, 许可慰. EDGE SP1000单孔手术机器人辅助腹腔镜下猪输尿管部分切除联合端端吻合术的可行性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 642-646.
阅读次数
全文


摘要