Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
Surg Today. 2012 Oct;42(10):940-4. doi: 10.1007/s00595-012-0218-5. Epub 2012 Jul 13.
To evaluate the outcomes of totally laparoscopic distal pancreatectomy (LDP).
A prospective database of patients treated within a single institution was studied retrospectively. Between March 2003 and January 2010, 15 patients underwent pancreatic transection with the use of a stapler, followed by sealing of the pancreatic stump with fibrin-coated collagen fleece (TachoComb) in LDP.
LDP was completed successfully in all 15 patients. The median operating time and blood loss were 168 min (range 105-213 min) and 36 ml (range 12-89 ml), respectively. The median drain amylase level peaked at 969 IU/l (93-3077 IU/l) on postoperative day (POD) 1, and then dropped to 165 IU/l (30-846 IU/l) on POD 3. The median hospital stay was 7 days (range 4-15 days). Biochemical pancreatic leaks developed in three patients (20 %), but there was no clinical pancreatic fistula or postoperative hemorrhage.
Our study shows that the combined use of a stapler and TachoComb decreased the incidence of pancreatic fistulas after LDP. This procedure offers more efficient and consistent results than those achieved by closing the pancreatic stump by stapling alone.
评估完全腹腔镜胰体尾切除术（LDP）的结果。
回顾性分析单中心接受治疗的患者的前瞻性数据库。2003 年 3 月至 2010 年 1 月，15 例患者接受了使用吻合器进行胰腺横断术，然后使用纤维蛋白涂层胶原毡（TachoComb）对胰管残端进行密封。
所有 15 例患者均成功完成 LDP。中位手术时间和出血量分别为 168 分钟（范围 105-213 分钟）和 36 毫升（范围 12-89 毫升）。术后第 1 天引流淀粉酶水平中位数为 969IU/L（93-3077IU/L），第 3 天降至 165IU/L（30-846IU/L）。中位住院时间为 7 天（范围 4-15 天）。3 例患者（20%）发生生化性胰瘘，但无临床胰瘘或术后出血。
我们的研究表明，吻合器联合 TachoComb 可降低 LDP 后胰瘘的发生率。与单独使用吻合器闭合胰管残端相比，该方法可提供更有效和一致的结果。
