Institute of Minimal Access Surgery, King's College Hospital, London, UK.
HPB (Oxford). 2013 Jun;15(6):403-10. doi: 10.1111/hpb.12003. Epub 2012 Dec 2.
Splenic preservation during a distal pancreatectomy (SPDP) may be performed with splenic vessel ligation, known as Warshaw's Technique (WT) or splenic vessel preservation (SVP). The consensus on which approach is best is divided. A systematic review of evidence in the literature was undertaken with the aim of analysing the merits and disadvantages of both WT and SVP.
A systematic search of medical literature from 1985-2011 was undertaken to identify all comparative studies and case series on SPDP. Non-English papers, series with < 5 patients, technical reports and reviews were excluded. The remaining articles were reviewed considering the study design, surgical technique, outcomes and complications.
In 23 relevant studies, 356 patients underwent WT and 572 underwent SVP. In WT patients, the mean operating time (160 versus 215 min, P < 0.001), mean estimated blood loss (301 versus 390 ml, P < 0.001) and length of stay (8 versus 11 days, P < 0.001) was significantly less than the SVP patients, respectively. Considering complications, splenic infarction and splenectomy occurred more frequently in WT patients (P < 0.05).
WT is technically easier to perform than SVP but has a higher incidence of subsequent splenectomies. Surgeons should be able to perform both procedures and tailor the technique according to the patient.
在胰体尾切除术（SPDP）中可以通过结扎脾血管来保留脾脏，这被称为 Warshaw 技术（WT）或脾血管保留（SVP）。关于哪种方法更好的共识存在分歧。本系统评价旨在分析 WT 和 SVP 的优缺点，对文献中的证据进行了系统评价。
从 1985 年至 2011 年，对医学文献进行了系统搜索，以确定所有关于 SPDP 的比较研究和病例系列。排除非英语论文、<5 例的系列研究、技术报告和综述。考虑研究设计、手术技术、结果和并发症，对其余文章进行了回顾。
在 23 项相关研究中，356 例患者接受 WT，572 例患者接受 SVP。WT 患者的平均手术时间（160 分钟比 215 分钟，P<0.001）、平均估计失血量（301 毫升比 390 毫升，P<0.001）和住院时间（8 天比 11 天，P<0.001）明显少于 SVP 患者。考虑并发症，WT 患者脾梗死和脾切除术的发生率更高（P<0.05）。
WT 技术上比 SVP 更容易实施，但随后脾切除术的发生率更高。外科医生应该能够同时进行这两种手术，并根据患者的情况选择合适的技术。
