Department of Pancreatic Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China.
Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
J Gastrointest Surg. 2022 Feb;26(2):360-366. doi: 10.1007/s11605-021-05114-x. Epub 2021 Aug 17.
Several approaches have been reported during laparoscopic spleen-preserving distal pancreatectomy (LSPDP), such as medial, lateral, and posterior approaches. This study reports a tail-first approach that is mobilization of the pancreatic gland from tail to neck followed by division. The short-term outcomes are described.
Cases which underwent LSPDP from 2014 to 2020 at Qilu Hospital of Shandong University were included. Clinical parameters were collected and analyzed.
One hundred five cases were collected, including 54 Kimura, 45 Warshaw, and 6 modified-Warshaw procedures. Seventy-seven patients (73.3%) underwent LSPDP by a tail-first approach (TFA-LSPDP) and 28 (26.7%) by a medial approach (M-LSPDP). Compared with the M-LSPDP, the TFA-LSPDP group had a lower incidence of splenic infraction (9.1 VS 25.0%, P = 0.05) and a higher frequency of Kimura procedure (55.8 VS 39.3%, P = 0.053).
TFA-LSPDP is feasible and safe for treatment of benign and low malignant lesions of the distal pancreas, which has a lower incidence of splenic infraction and a higher frequency of splenic vessel preservation compared with the traditional medial approach.
腹腔镜保留脾脏胰体尾切除术（LSPDP）有多种入路方法，包括内侧、外侧和后侧入路。本研究报道了一种从胰尾到头侧的胰腺腺叶先游离后离断的胰尾优先入路方法，并描述了其短期结果。
纳入 2014 年至 2020 年在山东大学齐鲁医院行 LSPDP 的病例。收集并分析临床参数。
共纳入 105 例患者，其中 Kimura 手术 54 例，Warshaw 手术 45 例，改良 Warshaw 手术 6 例。77 例（73.3%）采用胰尾优先入路（TFA-LSPDP），28 例（26.7%）采用内侧入路（M-LSPDP）。与 M-LSPDP 相比，TFA-LSPDP 组脾梗死发生率较低（9.1%比 25.0%，P=0.05），Kimura 手术比例较高（55.8%比 39.3%，P=0.053）。
TFA-LSPDP 治疗胰腺远端良性和低度恶性病变是可行和安全的，与传统的内侧入路相比，TFA-LSPDP 脾梗死发生率较低，脾血管保留率较高。
