Yadav Thakur Deen, Natarajan Sabareesh Kumar, Kishore Venkata Murali Gottapu, Lyngdoh Soni, Wig Jai Dev
Department of Surgery, Postgraduate Institute of Medical Education and Research. Chandigarh, India.
JOP. 2007 Jul 9;8(4):422-8.
Spleen-preserving distal pancreatectomy is a well-accepted procedure for benign tumors of the distal pancreas. Its safety and feasibility have been proven. However many doctors have not used this procedure due to the trauma involved.
We present our experience of six cases of distal pancreatic trauma where we managed to preserve the spleen during distal pancreatectomy in an emergency procedure.
Prospective analysis of the data.
Patients with distal pancreatic trauma admitted to the Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh between July 2001 and June 2005.
A spleen-preserving distal pancreatectomy was performed by preserving the splenic vessels to maintain a reliable splenic blood flow. Patients who were unstable after adequate resuscitation were excluded.
The preoperative characteristics, intraoperative findings and postoperative complications with follow-up were studied.
Six patients were found suitable for spleen-preserving distal pancreatectomy based on their general condition and a preoperative spleen CECT. Five patients had been injured in car accidents and one patient had sustained a stab injury. The average duration of the surgery was 4.75+/-0.25 hours. All patients had associated hollow viscus injury which was repaired along with the spleen-preserving distal pancreatectomy. The most common post-operative complication was fever with basal atelectasis. One patient died postoperatively from hemodynamic instability. The other five patients are doing well and have not developed pancreatic endocrine insufficiency.
Although technically demanding, a spleen-preserving distal pancreatectomy can be performed safely in an emergency, and it avoids splenectomy-related problems in the post-operative period.
保留脾脏的胰体尾切除术是治疗胰体尾良性肿瘤的一种广泛认可的手术方法。其安全性和可行性已得到证实。然而，由于该手术涉及创伤，许多医生尚未采用此方法。
我们介绍6例胰体尾外伤患者的治疗经验，在急诊手术中，我们成功地在胰体尾切除术中保留了脾脏。
对数据进行前瞻性分析。
2001年7月至2005年6月间，印度昌迪加尔医学教育与研究研究生院外科收治的胰体尾外伤患者。
通过保留脾血管以维持可靠的脾血流，实施保留脾脏的胰体尾切除术。充分复苏后仍不稳定的患者被排除。
研究术前特征、术中发现及随访的术后并发症。
根据患者的一般状况和术前脾脏CT增强扫描，6例患者适合行保留脾脏的胰体尾切除术。5例患者因车祸受伤，1例患者遭受刺伤。手术平均时长为4.75±0.25小时。所有患者均合并中空脏器损伤，在保留脾脏的胰体尾切除术同时进行了修复。最常见的术后并发症是发热伴基底肺不张。1例患者术后因血流动力学不稳定死亡。其他5例患者情况良好，未出现胰腺内分泌功能不全。
尽管技术要求较高，但在急诊情况下，保留脾脏的胰体尾切除术可以安全实施，并且可避免术后与脾切除相关的问题。
