Vezakis A, Davides D, Larvin M, McMahon M J
Leeds Institute for Minimally Invasive Surgery, and the Centre for Digestive Diseases, the General Infirmary at Leeds Great Gorge Street, Leeds, England LS1 3EX.
Surg Endosc. 1999 Jan;13(1):26-9. doi: 10.1007/s004649900891.
Laparoscopic distal pancreatectomy combined with spleen salvage by preservation of the splenic vessels has been described in selected patients with islet cell tumors.
Laparoscopic resection of the left side of the pancreas with spleen preservation on the vasa brevia was attempted in six consecutive patients.
Four distal pancreatectomies with spleen preservation were completed laparoscopically. There were two conversions to laparotomy. The median operating time was 300 min (range, 240-360). There was no mortality, but two patients developed a pancreatic fistula. The median postoperative hospital stay was 34.5 days (range, 5-60). All the patients remain well at a median follow-up of 30 months (range, 22-41).
Minimally invasive surgery for distal pancreatic tumors is feasible and appropriate for most benign tumors. The spleen can be safely preserved laparoscopically on its blood supply from the short gastric vessels. The operative technique and especially the closure of the pancreatic stump need further study.
对于部分胰岛细胞瘤患者，已报道采用保留脾血管的腹腔镜远端胰腺切除术联合保脾手术。
对连续6例患者尝试在保留胃短血管的情况下行腹腔镜下胰腺左侧切除并保脾。
4例成功完成腹腔镜下远端胰腺切除并保脾手术，2例中转开腹。中位手术时间为300分钟（范围240 - 360分钟）。无死亡病例，但2例患者发生胰瘘。术后中位住院时间为34.5天（范围5 - 60天）。所有患者在中位随访30个月（范围22 - 41个月）时情况良好。
对于大多数良性胰腺远端肿瘤，微创手术是可行且合适的。通过保留胃短血管的血供，可在腹腔镜下安全保留脾脏。手术技术，尤其是胰腺残端的闭合仍需进一步研究。
