Royal Brisbane Hospital, Herston, QLD, Australia.
HPB (Oxford). 2008;10(1):38-42. doi: 10.1080/13651820701802312.
Laparoscopic distal pancreatectomy (LDP) is a safe alternative to conventional open distal pancreatectomy, with advantages that include smaller incisions, less pain, and shorter postoperative recovery. Despite these apparent advantages, however, uptake of the procedure has been slow, with only a handful of series published.
All LDPs performed in Brisbane, Australia, over a 10-year period (May 1996 to June 2006) were retrospectively reviewed.
Forty-six consecutive LDPs were performed. A variety of lesions were resected, including nine cancers. Twelve patients were converted for oncological (6) or technical reasons (6). The spleen was retained in 14/29 patients, either by main splenic vessel preservation (9) or solely supported by the short gastric vessels (5), resulting in inferior pole infarction in 2 patients. Overall morbidity was 39%, including 15% pancreatic fistula. All fistulas resolved after a median of 6 weeks without re-operation. A non-significant trend toward fewer fistulas with stapled rather than sutured stump closure was observed (13% vs 19%; p=0.43). Median operative duration and hospital stay were 157 min and 7 days, respectively. There was no mortality.
LDP is a safe alternative to conventional resection for a wide range of lesions. As with open resection, pancreatic fistula is the dominant morbidity, but is generally indolent. While spleen preservation is often possible, care must be taken to avoid infarction of the inferior pole if the Warshaw technique is utilized.
腹腔镜下胰体尾切除术（LDP）是一种安全的替代传统开腹胰体尾切除术的方法，具有切口小、疼痛少、术后恢复快等优点。然而，尽管有这些明显的优势，该手术的采用率仍然很低，只有少数几篇系列报道。
回顾性分析了 1996 年 5 月至 2006 年 6 月期间在澳大利亚布里斯班进行的所有 10 年内的 46 例连续 LDP 病例。
46 例连续进行了 LDP。切除了多种病变，包括 9 例癌症。由于肿瘤学（6 例）或技术原因（6 例），有 12 例患者转为开腹手术。29 例患者中有 14 例保留了脾脏，其中 9 例通过保留主脾血管，5 例仅通过胃短血管支撑，导致 2 例患者下极梗死。总发病率为 39%，包括 15%的胰瘘。所有瘘管在中位数为 6 周的时间内未经再次手术自行愈合。观察到吻合器关闭残端比缝合关闭残端的瘘管发生率略低（13% vs 19%；p=0.43）。手术时间和住院时间中位数分别为 157 分钟和 7 天，无死亡病例。
LDP 是一种广泛病变的安全替代传统切除的方法。与开腹切除一样，胰瘘是主要的并发症，但通常是惰性的。虽然脾脏保留通常是可行的，但如果采用 Warshaw 技术，必须小心避免下极梗死。
