Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia; Department of Surgery, University of Auckland, Auckland, New Zealand.
HPB (Oxford). 2020 Nov;22(11):1563-1568. doi: 10.1016/j.hpb.2020.01.012. Epub 2020 Feb 17.
Spleen preservation during distal pancreatectomy (SpDP) can be accomplished by a variety of surgical approaches, but the impact on spleen function is unknown. This study aimed to compare spleen volume, function and complications between patients who underwent vessel sparing (VSDP) vs. vessel ligating (Warshaw, WDP) SpDP.
All patients who underwent SpDP at the Toronto General Hospital from 2006 to 2015 were included. Primary outcomes were pre- and post-operative spleen volumes and contrast enhancement on CT, hematologic parameters, and spleen-related complications.
82 patients underwent SpDP with median follow up of 20.4 months. Splenic volumes were able to be calculated on 44 patients (VSDP n = 8, WDP n = 36). There was no difference between WDP and VSDP in operative duration, blood loss, hospital length of stay, or Clavien-Dindo ≥3 complication rate. Spleen volumes did not differ from baseline in either group. On postoperative imaging more WDP patients had areas of splenic hypoperfusion (p = 0.032). These differences resolved by 3 months after surgery, there were no instances of long term infectious or bleeding complications related to poor splenic function or gastric varices.
Both WDP and VSDP achieve splenic preservation. Neither technique resulted in clinically apparent spleen related complications. There is no difference in splenic volume and function in the short/long term.
远端胰腺切除术（SpDP）过程中可以通过多种手术方法来保留脾脏，但对脾脏功能的影响尚不清楚。本研究旨在比较血管保留（VSDP）与血管结扎（Warshaw，WDP）SpDP 两种方法对脾脏体积、功能和并发症的影响。
纳入 2006 年至 2015 年期间在多伦多总医院行 SpDP 的所有患者。主要结局为术前和术后 CT 上的脾脏体积和对比增强、血液学参数以及与脾脏相关的并发症。
82 例患者行 SpDP，中位随访时间为 20.4 个月。44 例患者可计算脾脏体积（VSDP n=8，WDP n=36）。WDP 与 VSDP 之间手术时间、出血量、住院时间或 Clavien-Dindo ≥3 级并发症发生率无差异。两组患者的脾脏体积与基线相比均无差异。术后影像学检查显示，更多的 WDP 患者存在脾脏灌注不足区域（p=0.032）。这些差异在术后 3 个月得到解决，无与脾脏功能不良或胃静脉曲张相关的长期感染或出血并发症。
WDP 和 VSDP 均可保留脾脏。两种技术均未导致明显的脾脏相关并发症。在短期/长期内，脾脏体积和功能没有差异。
