Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Surg Endosc. 2019 Oct;33(10):3314-3324. doi: 10.1007/s00464-018-06621-w. Epub 2018 Dec 7.
Recently, laparoscopic distal pancreatectomy (LDP) has become the standard procedure for resection of left-sided pancreatic tumors. Fluid collection (FC) at the resection margin of the pancreatic stump after LDP is a frequent radiological finding. However, there have been few treatment guidelines and the optimal management for this clinical finding is unclear. The aim of present study is to define the incidence of FC and suggest the optimal management for FC after LDP.
A total of 1227 patients who underwent LDP between March 2005 and December 2015 were collected. FC was considered present when the longest diameter of the lesion on CT scan was > 3 cm.
A follow-up with at least two CT image was available for 1102 patients. Of these, 689 (62.5%) patients showed initial fluid collection (IFC) at the pancreas resection site in immediate postoperative CT. IFC (+) group had higher proportion of men, BMI, and higher rate of concomitant splenectomy than IFC (-) group. Among patients with FC after LDP, the treatment group had more frequent leukocytosis and accompanying symptoms than the observation group. Seventy-seven patients underwent therapeutic interventions for FC after LDP. Among them, 55 (71.4%) patients underwent endoscopic ultrasonography-guided gastrocystostomy (EUS-GC). EUS-GC group had a higher success rate (85.6 vs. 63.6%, p < 0.033) and shorter hospital stay after the intervention (5.2 vs. 13.3 days, p < 0.001) than those who underwent other procedures.
High BMI, male, and concomitant splenectomy contribute to the occurrence of FC after LDP. In most cases, FC after LDP resolved spontaneously over time with observation. The patients with symptomatic FC ultimately required treatment. EUS-GC is the optimal intervention therapy for FC after LDP.
最近，腹腔镜胰体尾切除术（LDP）已成为切除左侧胰腺肿瘤的标准手术方式。LDP 后胰腺残端的切缘处出现液体聚集（FC）是一种常见的影像学表现。然而，目前还没有相关的治疗指南，对于这种临床发现的最佳处理方法尚不清楚。本研究旨在明确 FC 的发生率，并提出 LDP 后 FC 的最佳处理方法。
共收集了 2005 年 3 月至 2015 年 12 月期间接受 LDP 的 1227 例患者。当 CT 扫描上病变的最长直径>3cm 时，认为存在 FC。
1102 例患者至少有两次 CT 随访。其中，689 例（62.5%）患者在术后即刻的 CT 上显示胰腺残端有初始 FC。IFC（+）组的男性、BMI 较高，且同时行脾切除术的比例高于 IFC（-）组。在 LDP 后出现 FC 的患者中，治疗组的白细胞增多和伴随症状的发生率高于观察组。77 例患者因 FC 而行 LDP 后的治疗性干预。其中，55 例（71.4%）患者行内镜超声引导下胃造口术（EUS-GC）。EUS-GC 组的成功率（85.6%比 63.6%，p<0.033）和干预后住院时间（5.2 天比 13.3 天，p<0.001）均高于其他治疗方法。
高 BMI、男性和同时行脾切除术是 LDP 后 FC 发生的危险因素。大多数情况下，LDP 后 FC 会随着时间的推移而自发消退，无需治疗。有症状的 FC 患者最终需要治疗。EUS-GC 是 LDP 后 FC 的最佳介入治疗方法。
