机器人与腹腔镜保留脾脏胰体尾切除术安全性及疗效比较

doi:10.3877/cma.j.issn.2095-3232.2026.04.010

目的

对比机器人辅助保留脾脏胰体尾切除术（RSPDP）与传统腹腔镜保留脾脏胰体尾切除术（LSPDP）治疗胰腺体尾部良性或低度恶性病变患者围手术期的安全性和临床疗效，探讨RSPDP患者临床获益情况。

方法

回顾性分析2019年1月至2024年12月在贵州医科大学附属医院行保留脾脏胰体尾切除术的35例胰腺体尾部良性或低度恶性患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男12例，女23例；平均年龄（51±19）岁。根据手术方式不同分为RSPDP组（14例）和LSPDP组（21例），两组患者根据术中具体情况选择Kimura法和Warshaw法行保留脾脏胰体尾切除术。两组围手术期指标比较采用秩和检验，并发症发生率等比较采用Fisher确切概率法。

结果

两组患者均手术顺利，无围手术期死亡。RSPDP组采用Kimura术式9例，LSPDP组Kimura术式14例；两组术中脾脏血管保留率分别为64%（9/14）、67%（14/21），差异无统计学意义（P>0.999）。RSPDP组术中出血量中位数为40 （20，63） ml，明显少于LSPDP组的100（50，300） ml（Z=-2.638，P=0.007）。两组手术时间、输血情况等比较差异无统计学意义（P>0.05）；两组术后引流液淀粉酶量、拔管时间及脾梗死、胰瘘、腹腔感染发生率比较差异亦无统计学意义（P>0.05）。

结论

对于胰腺体尾部良性或低度恶性病变患者，采用RSPDP和LSPDP术均是安全的，两组手术时间、术后恢复情况无明显差异，但相较于LSPDP，RSPDP术中出血量更低。

关键词: 胰腺肿瘤, 保留脾脏胰体尾切除术, 机器人手术, 腹腔镜手术, 临床疗效

Objective

To compare perioperative safety and efficacy of robot-assisted spleen-preserving distal pancreatectomy (RSPDP) and laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for benign or low-grade malignant lesions of pancreatic body and tail, and to evaluate clinical benefits of RSPDP patients.

Methods

Clinical data of 35 patients with benign or low-grade malignant lesions of pancreatic body and tail undergoing spleen-preserving distal splenectomy in the Affiliated Hospital of Guizhou Medical University from January 2019 to December 2024 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 23 female, aged (51±19) years on average. According to different surgical methods, all patients were divided into the RSPDP group (n=14) and LSPDP group (n=21). According to specific conditions during the surgery, spleen-preserving distal pancreatectomy was performed using Kimura or Warshaw technique. Perioperative indexes between two groups were compared by rank-sum test, and the incidence of complications was compared by Fisher's exact test.

Results

All patients in two groups successfully completed the surgery, and no perioperative death occurred. In the RSPDP group, Kimura technique was adopted in 9 cases, and 14 cases in the LSPDP group. The splenic vessel-preserving rates in two groups were 64%(9/14) and 67%(14/21), with no statistical significance (P>0.999). The median intraoperative blood loss in the RSPDP group was 40(20,63) ml, significantly less than 100(50,300) ml in the LSPDP group (Z=-2.638, P=0.007). No significant difference was observed in operation time and blood transfusion amount between two groups (all P>0.05). No significant difference was found in the amount of amylase in drainage fluid, extubation time and the incidence of splenic infarction, pancreatic fistula and abdominal infection rate between two groups (all P>0.05).

Conclusions

Both RSPDP and LSPDP are safe for patients with benign or low-grade malignant lesions of pancreatic body and tail. No significant difference is observed in operation time and postoperative recovery between two groups. Compared with LSPDP, RSPDP leads to a lower amount of intraoperative bleeding.

Key words: Pancreatic neoplasm, Spleen-preserving distal pancreatectomy, Robotic surgery, Laparoscopy, Clinical efficacy

表1 两组胰腺肿瘤患者胰体尾切除术前一般资料比较

指标	RSPDP组	LSPDP组	统计值	P值
男性[例(%)]	5(36)	7(33)	-	>0.999
年龄(岁, $x ¯$ ±s)	51±19	40±15	t=1.844	0.074
BMI(kg/m², $x ¯$ ±s)	23.6±3.7	22.4±2.5	t=1.073	0.291
烟酒史[例(%)]	4(33)	4(20)	-	0.685
合并基础疾病[例(%)]	4(75)	2(10)	-	0.191
胰管扩张[例(%)]	4(33)	10(50)	-	0.311
WBC(×10⁹/L, $x ¯$ ±s)	6.9±1.7	6.4±1.9	t=0.740	0.465
Hb(g/L, $x ¯$ ±s)	140±10	135±16	t=1.296	0.204
Plt(×10⁹/L, $x ¯$ ±s)	226±68	220±207	t=0.301	0.765
ALB(g/L)	42(40, 47)	44(41, 47)	Z=-0.909	0.373
血糖[mmol/L, M(Q₁, Q₃)]	5.3(4.5, 5.5)	4.9(4.4, 6.0)	Z=0.152	0.888
TB(μmol/L, $x ¯$ ±s)	12±4	10±5	t=0.980	0.334
ALT[U/L, M(Q₁, Q₃)]	19(9, 25)	12 (10, 25)	Z=0.236	0.823
AST[U/L, M(Q₁, Q₃)]	20(17, 24)	17 (15, 26)	Z=1.263	0.213
Scr[μmol/L, M(Q₁, Q₃)]	70(61, 76)	64 (52, 67)	Z=2.004	0.045
PT(s, $x ¯$ ±s)	12.6±1.4	12.5±1.3	t=0.191	0.850
APTT(s, $x ¯$ ±s)	35±5	34±4	t=0.624	0.537
纤维蛋白原[g/L, M(Q₁, Q₃)]	3.3(2.7, 3.5)	2.9(2.5, 3.7)	Z=0.707	0.490

表1 两组胰腺肿瘤患者胰体尾切除术前一般资料比较

指标	RSPDP组	LSPDP组	统计值	P值
男性[例(%)]	5(36)	7(33)	-	>0.999
年龄(岁, $x ¯$ ±s)	51±19	40±15	t=1.844	0.074
BMI(kg/m², $x ¯$ ±s)	23.6±3.7	22.4±2.5	t=1.073	0.291
烟酒史[例(%)]	4(33)	4(20)	-	0.685
合并基础疾病[例(%)]	4(75)	2(10)	-	0.191
胰管扩张[例(%)]	4(33)	10(50)	-	0.311
WBC(×10⁹/L, $x ¯$ ±s)	6.9±1.7	6.4±1.9	t=0.740	0.465
Hb(g/L, $x ¯$ ±s)	140±10	135±16	t=1.296	0.204
Plt(×10⁹/L, $x ¯$ ±s)	226±68	220±207	t=0.301	0.765
ALB(g/L)	42(40, 47)	44(41, 47)	Z=-0.909	0.373
血糖[mmol/L, M(Q₁, Q₃)]	5.3(4.5, 5.5)	4.9(4.4, 6.0)	Z=0.152	0.888
TB(μmol/L, $x ¯$ ±s)	12±4	10±5	t=0.980	0.334
ALT[U/L, M(Q₁, Q₃)]	19(9, 25)	12 (10, 25)	Z=0.236	0.823
AST[U/L, M(Q₁, Q₃)]	20(17, 24)	17 (15, 26)	Z=1.263	0.213
Scr[μmol/L, M(Q₁, Q₃)]	70(61, 76)	64 (52, 67)	Z=2.004	0.045
PT(s, $x ¯$ ±s)	12.6±1.4	12.5±1.3	t=0.191	0.850
APTT(s, $x ¯$ ±s)	35±5	34±4	t=0.624	0.537
纤维蛋白原[g/L, M(Q₁, Q₃)]	3.3(2.7, 3.5)	2.9(2.5, 3.7)	Z=0.707	0.490

表2 两组胰腺肿瘤患者胰体尾切除术中情况比较

组别	例数	手术时间(min, $x ¯$ ±s)	术中出血量[ml, M(Q₁, Q₃)]	术中输血[例(%)]	保留脾脏血管[例(%)]
RSPDP组	14	267±94	40(20, 63)	0	9(64)
LSPDP组	21	237±49	100(50, 300)	2(10)	14(67)
统计值		t=1.096	Z=-2.638	-	-
P值		0.288	0.007	0.506	>0.999

表2 两组胰腺肿瘤患者胰体尾切除术中情况比较

组别	例数	手术时间(min, $x ¯$ ±s)	术中出血量[ml, M(Q₁, Q₃)]	术中输血[例(%)]	保留脾脏血管[例(%)]
RSPDP组	14	267±94	40(20, 63)	0	9(64)
LSPDP组	21	237±49	100(50, 300)	2(10)	14(67)
统计值		t=1.096	Z=-2.638	-	-
P值		0.288	0.007	0.506	>0.999

表3 两组胰腺肿瘤患者胰体尾切除术后情况比较

项目	RSPDP组	LSPDP组	统计值	P值
术后3 d引流液淀粉酶[U/L, M(Q₁, Q₃)]	7 901(689, 15 583)	6 744(4 483, 21 094)	Z=0.910	0.372
引流管拔管时间(d, $x ¯$ ±s)	9±4	10±5	t=-0.999	0.325
胃管拔管时间[d, M(Q₁, Q₃)]	2.0(1.0, 6.5)	1.0(1.0, 2.5)	Z=1.531	0.133
进食时间[d, M(Q₁, Q₃)]	3.5(2.0, 5.3)	4.0(3.0, 5.5)	Z=-0.955	0.349
术后下床活动时间[d, M(Q₁, Q₃)]	4.0(1.8, 6.3)	4.0(2.0, 6.5)	Z=-0.051	0.966
术后住院时间[d, M(Q₁, Q₃)]	10.0(6.0, 14.5)	9.0(8.0, 15.5)	Z=0.272	0.795

表3 两组胰腺肿瘤患者胰体尾切除术后情况比较

项目	RSPDP组	LSPDP组	统计值	P值
术后3 d引流液淀粉酶[U/L, M(Q₁, Q₃)]	7 901(689, 15 583)	6 744(4 483, 21 094)	Z=0.910	0.372
引流管拔管时间(d, $x ¯$ ±s)	9±4	10±5	t=-0.999	0.325
胃管拔管时间[d, M(Q₁, Q₃)]	2.0(1.0, 6.5)	1.0(1.0, 2.5)	Z=1.531	0.133
进食时间[d, M(Q₁, Q₃)]	3.5(2.0, 5.3)	4.0(3.0, 5.5)	Z=-0.955	0.349
术后下床活动时间[d, M(Q₁, Q₃)]	4.0(1.8, 6.3)	4.0(2.0, 6.5)	Z=-0.051	0.966
术后住院时间[d, M(Q₁, Q₃)]	10.0(6.0, 14.5)	9.0(8.0, 15.5)	Z=0.272	0.795

表4 两组胰腺肿瘤患者胰体尾切除术后并发症比较 [例(%)]

组别	例数	脾梗死	胰瘘	腹腔感染	总体
RSPDP组	14	2(14)	3(21)	1(7)	6(43)
LSPDP组	21	2(10)	2(10)	2(10)	6(29)
统计值		-	-	-
P值		>0.999	0.369	>0.999	0.477

表4 两组胰腺肿瘤患者胰体尾切除术后并发症比较 [例(%)]

组别	例数	脾梗死	胰瘘	腹腔感染	总体
RSPDP组	14	2(14)	3(21)	1(7)	6(43)
LSPDP组	21	2(10)	2(10)	2(10)	6(29)
统计值		-	-	-
P值		>0.999	0.369	>0.999	0.477

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Comparison of safety and efficacy between robot-assisted and laparoscopic spleen-preserving distal pancreatectomy

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Comparison of safety and efficacy between robot-assisted and laparoscopic spleen-preserving distal pancreatectomy