Nagakawa Yuichi, Sahara Yatsuka, Hosokawa Yuichi, Takishita Chie, Kasuya Kazuhiko, Tsuchida Akihiko
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Dig Surg. 2017;34(4):289-297. doi: 10.1159/000452498. Epub 2017 Feb 15.
In laparoscopic distal pancreatectomy (LDP), isolating the splenic artery and vein requires advanced techniques. This study aimed to assess the efficacy of a novel method termed the 'straightened splenic vessels' (SSV) method for isolating the splenic vessels in LDP.
In SSV, to adjust the instrument axis, the splenic artery was straightened by grasping 2 points of its nerve sheath. Then, the layer between the splenic artery's nerve sheath and the pancreatic parenchyma was dissected. Next, the pancreas was mobilized from body to tail, and the splenic vein was straightened by 3-point retraction before isolation. To evaluate this method's efficacy, we investigated 51 patients who underwent LDP.
In 39 patients who underwent LDP with splenectomy, the mean operating time was significantly shorter in the SSV group than in the conventional group (p = 0.004). In 12 patients who underwent LDP with preserving the splenic vessels, the mean intraoperative blood loss in the SSV group was 27.6 ml, which was significantly lower than that in the conventional group (p = 0.012).
This method may be applied as a standard procedure with little blood loss and short operation time for LDP. Larger prospective studies are needed to further evaluate the feasibility.
在腹腔镜胰体尾切除术（LDP）中，分离脾动静脉需要先进的技术。本研究旨在评估一种名为“拉直脾血管”（SSV）的新方法在LDP中分离脾血管的效果。
在SSV方法中，为调整器械轴，通过抓住脾动脉神经鞘的两个点将其拉直。然后，解剖脾动脉神经鞘与胰腺实质之间的层面。接下来，将胰腺从体部向尾部游离，在分离前通过三点牵拉将脾静脉拉直。为评估该方法的效果，我们调查了51例行LDP的患者。
在39例行脾切除术的LDP患者中，SSV组的平均手术时间明显短于传统组（p = 0.004）。在12例行保留脾血管的LDP患者中，SSV组的平均术中失血量为27.6 ml，明显低于传统组（p = 0.012）。
该方法可作为LDP的一种标准术式应用，具有出血量少、手术时间短的特点。需要更大规模的前瞻性研究来进一步评估其可行性。
