Liang Lei, Ma Chaoqun, Liu Fangfeng, Ni Qingqiang, Song Xie, Zheng Shunzhen, Wang Zhengjian, Shi Huizhong, Chang Hong
Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Surgery. 2026 Feb;190:109893. doi: 10.1016/j.surg.2025.109893. Epub 2025 Nov 29.
We evaluated a third spleen-preserving approach-indocyanine green-guided laparoscopic partial spleen-preserving distal pancreatectomy-for benign or low-grade pancreatic body/tail tumors, in comparison with the Warshaw technique.
This was a single-center retrospective cohort study conducted between January 2020 and November 2024. Thirty-seven patients underwent laparoscopic partial spleen-preserving distal pancreatectomy (n = 15; preserving short gastric and superior polar vessels) versus Warshaw (n = 22). Intraoperative indocyanine green fluorescence was used to assess splenic perfusion. Outcomes included operative metrics, major morbidity (clinically relevant postoperative pancreatic fistula per International Study Group on Pancreatic Surgery 2016), radiologic splenic infarction, platelet counts, and health-related quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30).
Operative duration (222.1 ± 39.5 minutes vs 208.2 ± 29.9 minutes; P = .23), blood loss (199.5 ± 25.8 mL vs 188.8 ± 29.1 mL; P = .31), and clinically relevant postoperative pancreatic fistula (13.6% vs 13.3%; P = 1.00) did not differ between the 2 groups. Laparoscopic partial spleen-preserving distal pancreatectomy yielded lower radiologic splenic infarction (0% vs 31.8%; P = .028) and lower platelet counts on postoperative day 7 (≈156 vs 218 × 10/L; P = .01). Health-related quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) was assessed at baseline and at 1, 3, 6, and 12 months. Although overall trajectories were similar, global health status scores favored laparoscopic partial spleen-preserving distal pancreatectomy at 1 and 12 months (both P < .05).
By conserving the short gastric and superior polar vessels with indocyanine green-guided perfusion mapping, Laparoscopic partial spleen-preserving distal pancreatectomy preserves viable splenic parenchyma, reducing splenic infarction and postoperative thrombocytosis without increasing operative time, blood loss, or clinically relevant postoperative pancreatic fistula. Laparoscopic partial spleen-preserving distal pancreatectomy represents a viable third spleen-preserving option that broadens minimally invasive, organ-preserving strategies for distal pancreatectomy.
我们评估了一种第三种保留脾脏的方法——吲哚菁绿引导下的腹腔镜保留部分脾脏的远端胰腺切除术——用于治疗良性或低级别胰体/胰尾肿瘤，并与Warshaw术式进行比较。
这是一项于2020年1月至2024年11月在单中心进行的回顾性队列研究。37例患者接受了腹腔镜保留部分脾脏的远端胰腺切除术（n = 15；保留胃短血管和脾上极血管）与Warshaw术式（n = 22）。术中使用吲哚菁绿荧光评估脾脏灌注。结果包括手术指标、主要并发症（按照2016年国际胰腺手术研究组的标准为临床相关的术后胰瘘）、影像学脾梗死、血小板计数以及健康相关生活质量（欧洲癌症研究与治疗组织生活质量问卷核心30项）。
两组之间的手术时长（222.1 ± 39.5分钟 vs 208.2 ± 29.9分钟；P = 0.23）、失血量（199.5 ± 25.8 mL vs 188.8 ± 29.1 mL；P = 0.31）以及临床相关的术后胰瘘（13.6% vs 13.3%；P = 1.00）并无差异。腹腔镜保留部分脾脏的远端胰腺切除术导致更低的影像学脾梗死发生率（0% vs 31.8%；P = 0.028）以及术后第7天更低的血小板计数（≈156 vs 218×10/L；P = 0.01）。在基线以及1、3、6和12个月时评估了健康相关生活质量（欧洲癌症研究与治疗组织生活质量问卷核心30项）。尽管总体趋势相似，但在1个月和12个月时，整体健康状况评分更倾向于腹腔镜保留部分脾脏的远端胰腺切除术（均P < 0.05）。
通过吲哚菁绿引导的灌注成像保留胃短血管和脾上极血管，腹腔镜保留部分脾脏的远端胰腺切除术可保留存活的脾实质，减少脾梗死和术后血小板增多症，且不增加手术时间、失血量或临床相关的术后胰瘘。腹腔镜保留部分脾脏的远端胰腺切除术是一种可行的第三种保留脾脏的选择，拓宽了远端胰腺切除术的微创、保留器官策略。
