研究Kimura法微创保脾胰体尾切除术在胰腺良性和低度恶性肿瘤患者中的临床应用价值。

回顾性分析2010年5月至2017年12月在复旦大学附属华东医院行Kimura法微创胰体尾切除术的68例胰腺良性和低度恶性肿瘤患者临床资料。其中男27例，女41例；年龄14～82岁，中位年龄52岁。患者均签署知情同意书，符合医学伦理学规定。根据手术方式不同分为机器人组和腹腔镜组，根据有无保留脾脏，每组进一步分为保脾组和切脾组。分别比较保脾组和切脾组，腹腔镜组和机器人组的手术近期疗效。手术时间、术中出血量比较采用t检验，率的比较采用χ²检验或Fisher确切概率法。

68例均采用Kimura法胰体尾切除术，保脾成功率74%（50/68），其中机器人组保脾成功率73%（16/22），腹腔镜组74%（34/46），差异无统计学意义（χ²=0.005，P>0.05）。腹腔镜组手术时间和术中出血量分别为（152±9）min、（113±23）ml，明显少于机器人组的（238±22）min、（286±71）ml （t=-3.65，-2.95；P<0.05）。无围手术期死亡。在胰瘘发生率、术后腹腔内感染等方面，腹腔镜组与机器人组、保脾组与切脾组差异均无统计学意义（P>0.05）。

对胰腺良性和低度恶性肿瘤患者行Kimura法微创保脾胰体尾切除术安全、可行。腹腔镜和机器人手术保脾成功率相当，但腹腔镜手术在手术时间和术中出血量方面具有一定优势，腹腔镜手术可作为首选。

To evaluate the clinical application value of minimally invasive spleen-preserving distal pancreatectomy (Kimura) in patients with benign and low-grade malignant pancreatic tumors.

Clinical data of 68 patients with benign and low-grade pancreatic tumors who underwent minimally invasive spleen-preserving distal pancreatectomy (Kimura) in Huadong Hospital Affiliated to Fudan University from May 2010 to December 2017 were retrospectively analyzed. Among them, 27 patients were male and 41 female, aged 14-82 years with a median age of 52 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different surgical methods, all patients were divided into the robot group and laparoscopic group. According to whether spleen was preserved or not, each group was further divided into the spleen-preserving group and splenectomy group. The short-term surgical efficacy was statistically compared between the spleen-preserving and splenectomy groups, and between the robot and laparoscopic groups. The operation time and intraoperative blood loss were compared by using t test. The rate comparison was conducted by Chi-square test or Fisher's exact probability.

All 68 patients underwent Kimura distal pancreatectomy with a success spleen-preserving rate 74%(50/68), and it was 73%(16/22) in robot group and 74%(34/46) in laparoscopic group, where no significant difference was observed between two groups (χ²=0.005, P>0.05). The operation time and intraoperative blood loss in laparoscopic group were (152±9) min and (113±23) ml, significantly less than (238±22) min and (286±71) ml in robot group (t=-3.65, -2.95; P<0.05). No perioperative death occurred. No significant difference was observed in the incidence of pancreatic fistula and postoperative intra-abdominal infection between the laparoscopic and robot group, neither between the spleen-preserving and splenectomy group (P>0.05).

Minimally invasive spleen-preserving distal pancreatectomy (Kimura) is a safe and feasible operation for patients with benign and low-grade pancreatic tumors. Laparoscopic and robotic operations yield equivalent success rate of spleen-preserving, whereas laparoscopic operation has certain advantages in operation time and intraoperative blood loss, which can be the primary choice.