Kimura W, Inoue T, Futakawa N, Shinkai H, Han I, Muto T
First Department of Surgery, University of Tokyo, Japan.
Surgery. 1996 Nov;120(5):885-90. doi: 10.1016/s0039-6060(96)80099-7.
The significance of preserving the spleen has recently been shown. However, there are few reports of spleen-preserving distal pancreatectomy for lesions of the body and tail of the pancreas, and this procedure is not generally performed. The aim of this study was to clarify the technique and indications for spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for benign lesions of the distal pancreas.
Four patients (two each with an endocrine tumor and a cystic lesion) underwent the procedure. We also performed the spleen-preserving Puestow's procedure with removal of the tail of the pancreas in a 22-year-old male patient with familial chronic pancreatitis. An important technique is to remove the splenic vein from the pancreas from the body of the pancreas toward the spleen and to remove the splenic artery from the pancreas in the other direction. The splenic vein is identified behind the pancreas and within the thin connective tissue membrane, which is cut longitudinally above the splenic vein. It is important to remove the splenic vein from the pancreas from the body of the pancreas toward the spleen, because it is very difficult to remove it in the other direction. There are many branches from the splenic vein on both sides; these branches should be carefully ligated and cut. The pancreas is removed from the splenic artery from the spleen toward the head of the pancreas. This procedure is much easier than removal of the pancreas from the vein.
The postoperative course was uneventful in four of the five patients. A pancreatic fistula remained in one patient for several weeks. The mean and standard deviation of the operative blood loss, the duration of the operation, and the postoperative hospital stay in the four uneventful cases, excluding the one in which Puestow's procedure was performed, were 600 +/- 479 ml, 290 +/- 48 minutes, and 40 +/- 21 days, respectively. No severe complications occurred in any of the five patients.
Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein is easy and safe and should be performed for benign lesions of the distal pancreas.
近期已证实保留脾脏的重要性。然而，关于保留脾脏的胰体尾病变远端胰腺切除术的报道较少，且该手术一般不常开展。本研究的目的是阐明保留脾动静脉的远端胰腺切除术治疗远端胰腺良性病变的技术及适应证。
4例患者（2例为内分泌肿瘤，2例为囊性病变）接受了该手术。我们还对1例22岁患有家族性慢性胰腺炎的男性患者实施了保留脾脏的普斯托手术，切除了胰尾。一项重要技术是从胰体向脾脏方向将脾静脉从胰腺上分离，从胰腺上以相反方向分离脾动脉。脾静脉位于胰腺后方及薄结缔组织膜内，在脾静脉上方纵向切开该膜。从胰体向脾脏方向将脾静脉从胰腺上分离很重要，因为朝相反方向分离非常困难。脾静脉两侧有许多分支；应仔细结扎并切断这些分支。从脾脏向胰头方向将胰腺从脾动脉上分离。此操作比从静脉分离胰腺容易得多。
5例患者中有4例术后病程顺利。1例患者出现胰瘘持续数周。在4例顺利病例（不包括实施普斯托手术的那例）中，手术失血量、手术时长及术后住院时间的均值和标准差分别为600±479ml、290±48分钟和40±21天。5例患者均未发生严重并发症。
保留脾动静脉的远端胰腺切除术操作简便且安全，应适用于远端胰腺良性病变。
