Department of Surgery, Kumamoto Regional Medical Center, Kumamoto-city, Kumamoto, Japan.
Scand J Surg. 2012;101(3):156-9. doi: 10.1177/145749691210100303.
Distal pancreatectomy is the only effective treatment for cancers of the pancreatic body and tail. The recurrence rate after DP has remained high. In an effort to over-come this problem, we developed a no-touch surgical technique for DP. This is a pilot study to see if distal pancreatectomy can be technically done using a no-touch surgical technique with-out deteriorating the post-operative prognosis.
From November 2000 through May 2011, 16 pancreatic ductal adeno-carcinoma patients have been operated on using a no-touch technique by a single operator. We described the surgical technique, and we reported our preliminary experience. During the procedure, the pancreatic body and tail is neither grasped nor squeezed by the surgeon. And all drainage vessels from the pancreatic body and tail are ligated and divided during the early phase of the operation. Furthermore, for improved dissection of the retroperitoneal tissue (rightward and posterior margins), we use a hanging and clamping maneuver and dissection behind Gerota's fascia.
In the current series, the posterior and rightward resection margins were free in all patients, although seven were positive for anterior serosal invasion. The post-operative prognosis was not deteriorated with this technique.
No-touch distal pancreatectomy technique may have some theoretical advantages, which merit future investigation in randomized controlled trials.
胰体尾切除术是治疗胰体尾癌的唯一有效方法。但 DP 后的复发率仍然很高。为了克服这个问题，我们开发了一种 DP 的无接触手术技术。本研究旨在探讨无接触手术技术是否可以在不影响术后预后的情况下，用于技术上可行的胰体尾切除术。
从 2000 年 11 月至 2011 年 5 月，由一名外科医生采用无接触技术对 16 例胰腺导管腺癌患者进行了手术。我们描述了手术技术，并报告了我们的初步经验。在手术过程中，术者既不抓也不挤压胰体尾部。并且在手术早期结扎和切断来自胰体尾部的所有引流血管。此外，为了更好地游离腹膜后组织（右后缘），我们采用了悬挂和夹闭操作，并在格氏筋膜后面进行解剖。
在本系列中，尽管 7 例患者存在前浆膜侵犯，但所有患者的后缘和右侧切缘均为阴性。该技术并未使术后预后恶化。
无接触胰体尾切除术可能具有一些理论优势，值得在未来的随机对照试验中进一步研究。
