Rosales-Velderrain A, Stauffer J A, Bowers S P, Asbun H J
Department of Surgery, Mayo Clinic, Jacksonville, FL 32225, USA.
Minerva Gastroenterol Dietol. 2012 Sep;58(3):239-52.
Distal pancreatectomy is the therapeutic option of choice for patients with a benign or malignant lesion located in the body and/or tail of the pancreas when surgical intervention is indicated. With recent advances in and wide spread use of imaging studies, lesions of the pancreas are being diagnosed more commonly and it is likely that this will translate into an increased number of patients undergoing surgical resection. The laparoscopic approach to pancreatic resections has not been adopted as rapidly as it has for most other general surgical procedures. This is despite the fact that the current literature appears to validate laparoscopy as an acceptable and safe approach for distal pancreatectomy in patients with benign lesions, and has demonstrated the known benefits inherent to the laparoscopic technique. These benefits include lower intraoperative blood loss, less pain and analgesic requirements, earlier return of bowel function, and shorter recovery and hospital stay. Yet controversy still exists for the role of laparoscopy in the resection of malignant lesions. Recent reports however, have shown that laparoscopic distal pancreatectomy can safely be performed in known malignancies and, most importantly, after a laparoscopic oncological resection, the oncological benchmarks that have been related to survival, (such as negative surgical margins and number of peripancreatic lymph nodes resected), can also be accomplished. We sought to review the current literature on distal pancreatectomy, specifically the indications, laparoscopic approaches, splenectomy and spleen-preserving techniques, intraoperative and short-term outcomes, morbidity, mortality and oncological outcomes.
对于胰腺体部和/或尾部存在良性或恶性病变且需要进行手术干预的患者，胰体尾切除术是首选的治疗方法。随着影像学研究的不断进步和广泛应用，胰腺病变的诊断越来越普遍，这可能会导致接受手术切除的患者数量增加。与大多数其他普通外科手术相比，腹腔镜胰腺切除术的采用速度并不快。尽管目前的文献似乎证实了腹腔镜手术对于患有良性病变的患者进行胰体尾切除术是一种可接受且安全的方法，并且已经证明了腹腔镜技术固有的已知益处。这些益处包括术中出血量少、疼痛和镇痛需求少、肠功能恢复早以及恢复和住院时间短。然而，腹腔镜手术在恶性病变切除中的作用仍存在争议。然而，最近的报告表明，腹腔镜胰体尾切除术可以安全地应用于已知的恶性肿瘤，最重要的是，在进行腹腔镜肿瘤切除术后，与生存相关的肿瘤学指标（如手术切缘阴性和切除的胰周淋巴结数量）也可以实现。我们试图回顾当前关于胰体尾切除术的文献，特别是其适应症、腹腔镜手术方法、脾切除术和保脾技术、术中及短期结果、发病率、死亡率和肿瘤学结果。
