Watanabe Yusuke, Nakata Kohei, Abe Toshiya, Ideno Noboru, Ikenaga Naoki, Nakamura Masafumi
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Surg Endosc. 2025 Sep 17. doi: 10.1007/s00464-025-12167-5.
Spleen-preserving distal pancreatectomy (SPDP) involves splenic vessel preservation (Kimura procedure) and splenic vessel resection (Warshaw procedure). This study evaluated the short- and long-term outcomes of the minimally invasive (MI) Kimura and Warshaw SPDP.
Medical records of 137 consecutive patients scheduled to undergo MI-SPDP (Kimura group, n = 72; Warshaw group, n = 65) between 2012 and 2024 were retrospectively reviewed.
The completion rate of the planned procedures was significantly lower in the Kimura group than in the Warshaw group (78% vs. 92%, P = 0.03). However, the patients experienced no major disadvantages due to procedural conversion. Most short-term outcomes were comparable between groups, with the exception of splenic infarction. The prevalence of radiological splenic infarction was significantly lower in the Kimura group than in the Warshaw group (5% vs. 38%, P < 0.01), although the splenic infarctions were clinically harmless. The incidence of perigastric and gastric intramural venous dilatation confirmed on computed tomography during follow-up was significantly lower in the Kimura group than in the Warshaw group (46% vs. 87%, P < 0.01; 21% vs. 39%, P = 0.04, respectively). The postoperative changes in splenic volume were significantly smaller in the Kimura group than in the Warshaw group (median, 17% vs. 28%, P = 0.04). However, 41% of patients in the Kimura group developed postoperative splenic venous stenosis during follow-up, most of whom had left-sided portal hypertension (LSPH), and postoperative splenic volume changes were significantly greater than those in patients who underwent the Warshaw procedure (median, 42% vs. 28%, P = 0.01).
In clinical practice, the short- and long-term outcomes of patients after both procedures were comparable. The Kimura procedure carries the potential risk of postoperative splenic venous stenosis during the follow-up period, which causes LSPH. Establishing the patient selection criteria and suitable surgical procedures to prevent splenic venous stenosis after the MI Kimura procedure is required.
保留脾脏的远端胰腺切除术（SPDP）包括保留脾血管（木村术式）和切除脾血管（华沙术式）。本研究评估了微创（MI）木村和华沙SPDP的短期和长期疗效。
回顾性分析2012年至2024年间连续137例行MI-SPDP患者的病历（木村组，n = 72；华沙组，n = 65）。
木村组计划手术的完成率显著低于华沙组（78%对92%，P = 0.03）。然而，患者未因手术转换而出现重大不利情况。除脾梗死外，两组间大多数短期疗效相当。木村组放射性脾梗死的发生率显著低于华沙组（5%对38%，P < 0.01），尽管这些脾梗死在临床上并无危害。随访期间计算机断层扫描证实的胃周和胃壁内静脉扩张的发生率，木村组显著低于华沙组（分别为46%对87%，P < 0.01；21%对39%，P = 0.04）。木村组术后脾体积的变化显著小于华沙组（中位数，17%对28%，P = 0.04）。然而，木村组41%的患者在随访期间出现术后脾静脉狭窄，其中大多数患有左侧门静脉高压（LSPH），且术后脾体积变化显著大于接受华沙术式的患者（中位数，42%对28%，P = 0.01）。
在临床实践中，两种手术患者的短期和长期疗效相当。木村术式在随访期间有术后脾静脉狭窄的潜在风险，可导致LSPH。需要制定患者选择标准和合适的手术方法以预防MI木村术后的脾静脉狭窄。
