Medical School of Ningbo University, Ningbo, China.
College of Information Science and Engineering, Ningbo University, Ningbo, China.
J Hepatobiliary Pancreat Sci. 2021 Aug;28(8):659-670. doi: 10.1002/jhbp.849. Epub 2020 Nov 9.
BACKGROUND/PURPOSE: To explore the risk factors of splenic vessel preservation in laparoscopic distal pancreatectomy (LDP) and to guide with the appropriate selection of surgical methods through three-dimensional (3D) reconstruction.
Patients suffering from benign or low-grade malignant tumors of pancreatic body and tail having undergone LDP in Ningbo Medical Center Lihuili Hospital from January 2014 to September 2019 were selected for quantitative analysis of the anatomical data of patients' pancreas, tumors, splenic vessels and spleens by 3D reconstruction. According to the final surgical methods, the patients were divided into the laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation (lap-SVP) group and the non-lap-SVP group. Clinical data of the two groups were compared to assess the risk factors for surgical failure of lap-SVP and logistic regression model was applied to predict the choice of surgical methods.
A total of 218 patients were included in the study, including 144 in the lap-SVP group and 74 in the non-lap-SVP group. Multivariate analysis confirms that large tumor volume, large contact area between the pancreas to be resected and the splenic vein, and large maximum ratio of the circumference of the splenic vessel embedded in the pancreas to be resected to the circumference of the splenic vessel are independent risk factors for surgical failure of lap-SVP (OR > 1, P < .05). The prediction accuracy of lap-SVP operation by the logistic regression reaches up to 80.9%.
3D reconstruction can provide essential basis for the surgical method selection of laparoscopic distal pancreatectomy.
背景/目的：通过三维（3D）重建探索腹腔镜胰体尾切除术（LDP）中保留脾脏血管的危险因素，为选择合适的手术方法提供指导。
选取 2014 年 1 月至 2019 年 9 月在宁波医疗中心李惠利医院行 LDP 的胰腺体尾部良性或低度恶性肿瘤患者，对患者胰腺、肿瘤、脾血管和脾脏的解剖学数据进行 3D 重建的定量分析。根据最终手术方法将患者分为腹腔镜保脾胰体尾切除术伴脾血管保留（lap-SVP）组和非 lap-SVP 组。比较两组患者的临床资料，评估 lap-SVP 手术失败的危险因素，并应用 logistic 回归模型预测手术方法的选择。
共纳入 218 例患者，其中 lap-SVP 组 144 例，非 lap-SVP 组 74 例。多因素分析证实，肿瘤体积大、待切除胰腺与脾静脉接触面积大、待切除胰腺包裹脾静脉的周径与脾静脉周径的最大比值大是 lap-SVP 手术失败的独立危险因素（OR>1，P<.05）。logistic 回归预测 lap-SVP 手术的准确率高达 80.9%。
3D 重建可为腹腔镜胰体尾切除术的手术方法选择提供重要依据。
