“实质离断优先”策略优于“隧道优先”策略，可在保留脾脏血管的机器人保脾胰远端切除术。
"Parenchyma transection-first" strategy is superior to "tunnel-first" strategy in robotic spleen-preserving distal pancreatectomy with conservation of splenic vessels.
机构信息
Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; School of Medicine, Nankai University, Tianjin 300071, China.
出版信息
Hepatobiliary Pancreat Dis Int. 2023 Dec;22(6):639-644. doi: 10.1016/j.hbpd.2023.06.007. Epub 2023 Jun 14.
BACKGROUND
Creating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection ("tunnel-first" strategy) has long been used in spleen-preserving distal pancreatectomy (SPDP) with splenic vessel preservation (Kimura's procedure). However, the operation space is limited in the tunnel, leading to the risks of bleeding and difficulties in suturing. We adopted the pancreatic "parenchyma transection-first" strategy to optimize Kimura's procedure.
METHODS
The clinical data of consecutive patients who underwent robotic SPDP with Kimura's procedure between January 2017 and September 2022 at our center were retrieved. The cohort was classified into a "parenchyma transection-first" strategy (P-F) group and a "tunnel-first" strategy (T-F) group and analyzed.
RESULTS
A total of 91 patients were enrolled in this cohort, with 49 in the T-F group and 42 in the P-F group. Compared with the T-F group, the P-F group had significantly shorter operative time (146.1 ± 39.2 min vs. 174.9 ± 46.6 min, P < 0.01) and lower estimated blood loss [40.0 (20.0-55.0) mL vs. 50.0 (20.0-100.0) mL, P = 0.03]. Failure of splenic vessel preservation occurred in 10.2% patients in the T-F group and 2.4% in the P-F group (P = 0.14). The grade 3/4 complications were similar between the two groups (P = 0.57). No differences in postoperative pancreatic fistula, abdominal infection or hemorrhage were observed between the two groups.
CONCLUSIONS
The pancreatic "parenchyma transection-first" strategy is safe and feasible compared with traditional "tunnel-first strategy" in SPDP with Kimura's procedure.
背景
在保留脾脏的胰远端切除术（SPDP）中，保留脾脏血管（Kimura 手术）时，在胰腺和脾血管之间创建隧道，然后横断胰腺实质（“隧道优先”策略）已经使用了很长时间。然而，在隧道中操作空间有限，导致出血和缝合困难的风险增加。我们采用胰腺“实质优先”策略来优化 Kimura 手术。
方法
回顾性分析 2017 年 1 月至 2022 年 9 月期间在我中心接受机器人 SPDP 合并 Kimura 手术的连续患者的临床资料。将该队列分为“实质优先”策略（P-F）组和“隧道优先”策略（T-F）组，并进行分析。
结果
本队列共纳入 91 例患者，T-F 组 49 例，P-F 组 42 例。与 T-F 组相比，P-F 组的手术时间明显更短（146.1±39.2 min 比 174.9±46.6 min，P＜0.01），估计出血量更低[40.0（20.0-55.0）mL 比 50.0（20.0-100.0）mL，P=0.03]。T-F 组中脾血管保留失败的发生率为 10.2%，P-F 组为 2.4%（P=0.14）。两组的 3/4 级并发症发生率相似（P=0.57）。两组术后胰瘘、腹部感染或出血无差异。
结论
与传统的“隧道优先”策略相比，在 Kimura 手术中，胰腺“实质优先”策略在 SPDP 中是安全可行的。
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