Tihanyi T F, Morvay K, Nehéz L, Winternitz T, Rusz Z, Flautner L E
1st Department of Surgery, Semmelweis University of Medicine, Budapest, Hungary.
Acta Chir Hung. 1997;36(1-4):359-61.
Management of the pancreatic diseases is still a challenge to the laparoscopic technique. Some experience has been gained in the laparoscopic exploration of the pancreas and staging in cancer. Anatomically the accessibility of the distal pancreas provides the laparoscopic approach technically feasible.
A case of insuloma in the tail of the pancreas is presented, where distal pancreatic resection was performed laparoscopically with the preservation of the spleen. In a 55 years old female patient with typical clinical symptoms of hyperinsulinism CT identified a 3 cm large solid tumor in the tail of the pancreas. Complete mobilization of the distal pancreas was enhanced by the use of an ultrasonic dissector (UltraCision). The pancreas is detached from the splenic hilum after dividing the spleen vessels. The pancreas is transected proximally by laparoscopic linear stapler. Preservation of the short gastric vessels provides the necessary blood supply of the spleen following division of the splenic artery and vein. Thus removal of the spleen is not a necessary step in this procedure. The operation was carried out within 4.5 hours. Postoperative course was uneventful, the patient left the hospital on the 5th postoperative day. Advantages of the procedure were the earlier mobilization and shorter recovery time, less postoperative pain. The procedure can be safely performed with a good experience in both pancreatic and laparoscopic surgery.
胰腺疾病的治疗对腹腔镜技术来说仍是一项挑战。在胰腺的腹腔镜探查及癌症分期方面已积累了一些经验。从解剖学角度看，胰腺远端的可达性使腹腔镜手术在技术上可行。
本文介绍一例胰腺尾部胰岛素瘤病例，该病例通过腹腔镜进行了保留脾脏的远端胰腺切除术。一名55岁女性患者有典型的高胰岛素血症临床症状，CT检查发现胰腺尾部有一个3厘米大的实性肿瘤。使用超声刀（UltraCision）增强了远端胰腺的完全游离。在切断脾血管后，将胰腺从脾门处分离。通过腹腔镜直线切割吻合器在胰腺近端进行横断。保留胃短血管可在脾动静脉切断后为脾脏提供必要的血液供应。因此，在该手术中切除脾脏并非必要步骤。手术在4.5小时内完成。术后过程顺利，患者术后第5天出院。该手术的优点是能更早地进行游离且恢复时间更短，术后疼痛更少。在胰腺手术和腹腔镜手术方面有丰富经验的情况下，该手术可安全实施。
