Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Langenbecks Arch Surg. 2021 Sep;406(6):1885-1892. doi: 10.1007/s00423-021-02101-3. Epub 2021 Mar 15.
Isolating the root of the splenic artery (SPA) is a challenging procedure in laparoscopic distal pancreatectomy (LDP). We investigated the usefulness of evaluation of the relationship between the SPA and pancreatic parenchyma using three-dimensional computed tomography (3D-CT).
In total, 104 patients were evaluated. The relationship between the SPA and pancreatic parenchyma was classified into two types: buried and non-buried. Video clips of 50 patients who underwent LDP requiring isolation of the SPA root were reviewed to determine whether the classification is related to difficulty of LDP.
Of the 50 assessed patients who underwent LDP, the relationship between the SPA and pancreatic parenchyma was the buried type in 30 (60.0%) and non-buried type in 20 (40.0%). The buried type was associated with a significantly longer median operative time than the non-buried type (285.0 vs. 235.5 min, respectively; P < 0.01). The median time required to isolate the SPA in the buried type (25.8 min; range, 4.0-101 min) was significantly longer than that in the non-buried type (7.0 min; range, 1.0-27.0 min) (P < 0.001).
Preoperative 3D-CT around the pancreas is practical for predicting the difficulty of SPA isolation and determining the safety of the procedure.
在腹腔镜胰体尾切除术（LDP）中，分离脾动脉（SPA）根部是一项具有挑战性的操作。我们研究了使用三维计算机断层扫描（3D-CT）评估 SPA 与胰腺实质之间关系的有用性。
共评估了 104 例患者。将 SPA 与胰腺实质之间的关系分为两种类型：埋藏型和非埋藏型。回顾了 50 例行 LDP 且需要分离 SPA 根部的患者的视频片段，以确定分类是否与 LDP 的难度有关。
在 50 例接受 LDP 的评估患者中，SPA 与胰腺实质之间的关系为埋藏型 30 例（60.0%），非埋藏型 20 例（40.0%）。埋藏型的中位手术时间明显长于非埋藏型（分别为 285.0 分钟和 235.5 分钟；P < 0.01）。埋藏型分离 SPA 的中位时间（25.8 分钟；范围 4.0-101 分钟）明显长于非埋藏型（7.0 分钟；范围 1.0-27.0 分钟）（P < 0.001）。
术前胰腺周围的 3D-CT 对于预测 SPA 分离的难度和确定手术的安全性是实用的。
