腹腔镜保脾胰体尾切除术治疗胰体尾癌的可行性探讨
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摘要
目的:探讨腹腔镜保脾胰体尾切除术治疗胰体尾癌的可行性。方法:回顾性分析2017年2月—2018年10月郑州大学附属洛阳中心医院行腹腔镜保脾胰体尾切除术治疗的9例胰体尾癌患者的临床资料。结果:全组9例患者手术均成功,无中转手术。手术时间140～320min,出血量150～550mL,无非计划二次手术,术后住院时间5～14d。术后发生A级胰瘘1例,B级胰瘘1例,经治疗后痊愈。患者均无术后大出血、脾坏死、C级胰瘘等重大并发症,随访1～20个月,未见肿瘤复发。全组患者无死亡。结论:LSPDP治疗低恶性的胰体尾癌是安全可行的,远期效果还需进一步累计资料进行评估。
引文
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[5]温天富,崔云甫.根治性顺行模块化胰脾切除术在胰体尾癌外科治疗中的应用进展[J].中华消化外科杂志,2016,15(6):641-644.doi:10.3760/cma.j.issn.1673-9752.2016.06.022.Wen TF,Cui YF.Updates of radical antegrade modular pancreatosplenectomy applied to the surgical treatment for pancreatic carcinoma of body and tail[J].Chinese Journal of Digestive Surgery,2016,15(6):641-644.doi:10.3760/cma.j.issn.1673-9752.2016.06.022.
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[9]Abu Hilal M,Hamdan M,Di Fabio F,et a1.Laparoscopic versus open distal pancreatectomy:a clinical and cost-effectiveness study[J].Surg Endosc,2012,26(6):1670-1674.doi:10.1007/s00464-011-2090-6.
[10]姚捷,钱建军,柏斗胜,等.完全腹腔镜下保留脾脏胰体尾切除术18例分析[J].中华胰腺病杂志,2015,15(1):6-9.doi:10.3760/cma.j.issn.1674-1935.2015.01.002.Yao J,Qian JJ,Bai DS,et a1.Total laparoscopic spleenpreserving distal pancreatectomy:report of 18 cases[J].Chinese Journal of Pancreatology,2015,15(1):6-9.doi:10.3760/cma.j.issn.1674-1935.2015.01.002..
[11]肖遵强,黄静,周新华,等.保留脾脏的腹腔镜胰体尾切除术与开腹胰体尾切除术的对照研究[J].中华普通外科杂志,2018,33(6):462-465.doi:10.3760/cma.j.issn.1007-631X.2018.06.006.Xiao ZQ,Huang J,Zhou XH,et al.Open vs.laparoscopic spleenpreserving distal pancreatectomy for benign pancreatic lesions[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2018,33(6):462-465.doi:10.3760/cma.j.issn.1007-631X.2018.06.006.
[12]Kuroki T,Eguchi S.Laparoscopic distal pancreatosplenectomy for pancreatic ductal adenocarcinoma[J].Surg Today,2015,45(7):808-812.doi:10.1007/s00595-014-1021-2
[13]Abu Hilal M,Takhar AS.Laparoscopic left pancreatectomy:current concepts[J].Pancreatology,2013,13(4):443-448.doi:10.1016/j.pan.2013.04.196.
[14]Toomey P,Hemandez J,Golkar F,et al.Pancreatic adenocarcinoma:complete tumor extirpation improves survival benefit despite larger tumors for patients who undergo distal pancreatectomy and splenectomy[J].J Gastrointest Surg,2012,16(2):376-381.doi:10.1007/s11605-011-1765-6.
[15]张维建,韩少良,蒋飞照,等.胰体尾癌的根治切除与外科疗效分析[J].中华肝胆外科杂志,2008,14(11):767-769.doi:10.3760/cma.j.issn.1007-8118.2008.11.005.Zhang WJ,Han SL,Jiang FZ,et al.Radical resection and analysis of surgical outcome for carcinoma of body and tail of pancreas[J].Chinese Journal of Hepatobiliary Surgery,,2008,14(11):767-769.doi:10.3760/cma.j.issn.1007-8118.2008.11.005.
[16]张太平,肖剑春,赵玉沛,等.胰体尾癌的规范化治疗[J].中国普外基础与临床杂志,2011,18(1):6-10.Zhang TP,Xiao JC,Zhao YP.Rational Treatment of Carcinoma of Body and Tail of Pancreas[J].Chin J Bases Clin General Surg,2008,18(1):6-10.
[17]马利林,沈洪薰,朱建伟,等.胰体尾部肿瘤的手术切除[J].中国普通外科杂志,2005,14(5):373-375.doi:10.3969/j.issn.1005-6947.2005.05.016.Ma LL,Shen HX,Zhu JW,et al.Surgical excision of tumors in the body and tail of pancreas[J].Chinese Journal of General Surgery,2005,2005,14(5):373-375.doi:10.3969/j.issn.1005-6947.2005.05.016.
[18]胡元国,黄强.胰体尾癌的诊治:附4 5例报告[J].中国普通外科杂志,2 0 1 5,2 4(3):3 4 3-3 4 6.d o i:1 0.3 9 7 8/j.issn.1005-6947.2015.03.007.Hu YG,Huang Q.Diagnosis and treatment of carcinoma of pancreatic body and tail:a report of 45 cases[J].Chinese Journal of General Surgery,2015,24(3):343-346.doi:10.3978/j.issn.1005-6947.2015.03.007.
[19]戚峰,邰升.联合腹腔干切除的胰体尾癌根治术[J].中华肝脏外科手术学电子杂志,2017,6(3):168-171.doi:10.3877/cma.j.issn.2095-3232.2017.03.005.Qi F,Tai S.Combined resection of celiac trunk in radical resection of cancer of body and tail of pancreas[J].Chinese Journal of Hepatic Surgery,2017,6(3):168-171.doi:10.3877/cma.j.issn.2095-3232.2017.03.005.
[20]徐权斌,郭洪春,王磊,等.术前评估有手术切除可能性的38例胰体尾癌临床诊治分析[J].中华胰腺病杂志,2014,14(2):122-124.doi:10.3760/cma.j.issn.1674-1935.2014.02.017.Xu QB,Guo HC,Wang L,et al.Analysis of clinical diagnosis and treatment of 38 cases of cancer of body and tail of pancreas with preoperative assessment of possible surgical resection[J].Chinese Journal of Pancreatology,2014,14(2):122-124.doi:10.3760/cma.j.issn.1674-1935.2014.02.017.
[21]王曦滔,顾万清,王宏光.胰体尾癌根治性切除手术:现状及展望[J].中华肝胆外科杂志,2016,22(3):213-216.doi:10.3760/cma.j.issn.1007-8118.2016.03.021.Wang XT,Gu WQ,Wang HG.Radical surgery for adenocarcinoma of body and tail of pancreas:current status and future perspectives[J].Chinese Journal of Hepatobiliary Surgery,2016,22(3):213-216.doi:10.3760/cma.j.issn.1007-8118.2016.03.021.
[22]Sahakyan MA,Kazaryan AM,Rawashdeh M,et al.Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma:results of a multicenter cohort study on 196 patients[J].Surg Endosc,2016,30(8):3409-3418.doi:10.1007/s00464-015-4623-x.
[23]孙志鹏,朱昱冰,阿民布和,等.腹腔镜保脾胰体尾整块切除手术治疗胰腺癌的技术细节及预后[J].首都医科大学学报,2017,38(5):733-739.doi:10.3969/j.issn.1006-7795.2017.05.019.Sun ZP,Zhu YB,Amin BH,et al.Detail of the en-bloc technique and prognosis of spleen-preserving laparoscopic distal pancreatectomy for pancreatic cancer[J].Journal of Capital Medical University,2017,38(5):733-739.doi:10.3969/j.issn.1006-7795.2017.05.019.
[24]刘峥嵘.脾脏保留对胰体尾切除术治疗胰腺神经内分泌肿瘤预后的影响[J].中国普通外科杂志,2015,24(9):1241-1244.doi:10.3978/j.issn.1005-6947.2015.09.007.Liu ZR.Influence of spleen preservation on prognosis of patients with pancreatic neuroendocrine neoplasms following distal pancreatectomy[J].Chinese Journal of General Surgery,2015,24(9):1241-1244.doi:10.3978/j.issn.1005-6947.2015.09.007.
[25]Tang CW,Feng WM,Bao Y,et al.Spleen-preserving distal pancreatectomy or distal pancreatectomy with splenectomy?:Perioperative and patient-reported outcome analysis[J].J Clin Gastroenterol,2014,48(7):e62-66.doi:10.1097/MCG.0000000000000021.
[26]Panda N,Bansal NK,Narsimhan M,et al.Spleen-Preserving Versus Spleen-Sacrificing Distal Pancreatectomy in Laparoscopy and Open Method-Perioperative Outcome Analysis-14 Years Experience[J].Indian J Surg,2016,78(2):90-95.doi:10.1007/s12262-015-1324-6.
[27]Rehman S,John SK,Lochan R,et al.Oncological feasibility of laparoscopic distal pancreatectomy for adenocarcinoma:a singleinstitution comparative study[J].World J Surg,2014,38(2):476-483.doi:10.1007/s00268-013-2268-2.
[28]Sahin TT,Fujii T,Kanda M,et a1.Prognostic implications of lymph node metastases in carcinoma of the body and tail of the pancreas[J].Pancreas,2011,40(7):1029-1033.doi:10.1097/MPA.0b013e3182207893.
[29]Diener MK,Knaebel HP,Witte ST,et al.DISPACT trial:a randomized controlled trial to compare two different surgical techniques of DIStal PAnCreaTectomy-study rationale and design[J].Clin Trials,2008,5(5):534-545.doi:10.1177/1740774508096140.
[30]Matsushima H,Kuroki T,Adachi T,et a1.Laparoscopic spleenpreserving distal pancreatectomy with and without splenic vessel preservation:the role of the Warshaw procedure[J].Pancreatology,2014,14(6):530-535.doi:10.1016/j.pan.2014.09.007.
[2]Hartwig W,Vollmer CM,Fingerhut A,et a1.Extended pancreatectomy in pancreatic ductal adenocarcinoma:definition and consensus of the International Study Group for Pancreatic Surgery(ISGPS)[J].Surgery,2014,156(1):1-14.doi:10.1016/j.surg.2014.02.009.
[3]Tol JA,Gouma DJ,Bassi C,et al.Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma:a consensus statement by the International Study Group on Pancreatic Surgery(ISGPS)[J].Surgery,2014,156(3):591-600.doi:10.1016/j.surg.2014.06.016.
[4]徐冬,蒋奎荣,陆子鹏,等.根治性顺行模块化胰脾切除术治疗胰体尾癌的临床疗效[J].中华消化外科杂志,2016,15(6):567-573.doi:10.3760/cma.j.issn.1673-9752.2016.06.010.Xu D,Jiang KR,Lu ZP,et al.Clinical effect of radical antegrade modular pancreatosplenectomy for carcinoma of pancreatic body and tail[J].Chinese Journal of Digestive Surgery,2016,15(6):567-573.doi:10.3760/cma.j.issn.1673-9752.2016.06.010.
[5]温天富,崔云甫.根治性顺行模块化胰脾切除术在胰体尾癌外科治疗中的应用进展[J].中华消化外科杂志,2016,15(6):641-644.doi:10.3760/cma.j.issn.1673-9752.2016.06.022.Wen TF,Cui YF.Updates of radical antegrade modular pancreatosplenectomy applied to the surgical treatment for pancreatic carcinoma of body and tail[J].Chinese Journal of Digestive Surgery,2016,15(6):641-644.doi:10.3760/cma.j.issn.1673-9752.2016.06.022.
[6]Kang CM,Lee SH,Lee WJ.Minimally invasive radical pancreatectomy for left-sided pancreatic cancer:Current status and future perspectives[J].World J Gastroenterol,2014,20(9):2343-2351.doi:10.3748/wjg.v20.i9.2343.
[7]Merchant NB,Parikh AA,Kooby DA.Should all distal pancreatectomies be performed laparoscopically?[J].Adv Surg,2009,43:283-300.
[8]陈军强,俞世安,许龙堂.腹腔镜保脾胰体尾切除治疗胰腺良性及交界性肿瘤[J].中华肝胆外科杂志,2018,24(5):329-332.doi:10.3760/cma.j.issn.1007-8118.2018.05.011.Chen JQ,Yu SA,Xu LT.Laparoscopic spleen-preserving distal pancreatectomy in the treatment of pancreatic benign and borderline tumors[J].Chinese Journal of Hepatobiliary Surgery,2018,24(5):329-332.doi:10.3760/cma.j.issn.1007-8118.2018.05.011.
[9]Abu Hilal M,Hamdan M,Di Fabio F,et a1.Laparoscopic versus open distal pancreatectomy:a clinical and cost-effectiveness study[J].Surg Endosc,2012,26(6):1670-1674.doi:10.1007/s00464-011-2090-6.
[10]姚捷,钱建军,柏斗胜,等.完全腹腔镜下保留脾脏胰体尾切除术18例分析[J].中华胰腺病杂志,2015,15(1):6-9.doi:10.3760/cma.j.issn.1674-1935.2015.01.002.Yao J,Qian JJ,Bai DS,et a1.Total laparoscopic spleenpreserving distal pancreatectomy:report of 18 cases[J].Chinese Journal of Pancreatology,2015,15(1):6-9.doi:10.3760/cma.j.issn.1674-1935.2015.01.002..
[11]肖遵强,黄静,周新华,等.保留脾脏的腹腔镜胰体尾切除术与开腹胰体尾切除术的对照研究[J].中华普通外科杂志,2018,33(6):462-465.doi:10.3760/cma.j.issn.1007-631X.2018.06.006.Xiao ZQ,Huang J,Zhou XH,et al.Open vs.laparoscopic spleenpreserving distal pancreatectomy for benign pancreatic lesions[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2018,33(6):462-465.doi:10.3760/cma.j.issn.1007-631X.2018.06.006.
[12]Kuroki T,Eguchi S.Laparoscopic distal pancreatosplenectomy for pancreatic ductal adenocarcinoma[J].Surg Today,2015,45(7):808-812.doi:10.1007/s00595-014-1021-2
[13]Abu Hilal M,Takhar AS.Laparoscopic left pancreatectomy:current concepts[J].Pancreatology,2013,13(4):443-448.doi:10.1016/j.pan.2013.04.196.
[14]Toomey P,Hemandez J,Golkar F,et al.Pancreatic adenocarcinoma:complete tumor extirpation improves survival benefit despite larger tumors for patients who undergo distal pancreatectomy and splenectomy[J].J Gastrointest Surg,2012,16(2):376-381.doi:10.1007/s11605-011-1765-6.
[15]张维建,韩少良,蒋飞照,等.胰体尾癌的根治切除与外科疗效分析[J].中华肝胆外科杂志,2008,14(11):767-769.doi:10.3760/cma.j.issn.1007-8118.2008.11.005.Zhang WJ,Han SL,Jiang FZ,et al.Radical resection and analysis of surgical outcome for carcinoma of body and tail of pancreas[J].Chinese Journal of Hepatobiliary Surgery,,2008,14(11):767-769.doi:10.3760/cma.j.issn.1007-8118.2008.11.005.
[16]张太平,肖剑春,赵玉沛,等.胰体尾癌的规范化治疗[J].中国普外基础与临床杂志,2011,18(1):6-10.Zhang TP,Xiao JC,Zhao YP.Rational Treatment of Carcinoma of Body and Tail of Pancreas[J].Chin J Bases Clin General Surg,2008,18(1):6-10.
[17]马利林,沈洪薰,朱建伟,等.胰体尾部肿瘤的手术切除[J].中国普通外科杂志,2005,14(5):373-375.doi:10.3969/j.issn.1005-6947.2005.05.016.Ma LL,Shen HX,Zhu JW,et al.Surgical excision of tumors in the body and tail of pancreas[J].Chinese Journal of General Surgery,2005,2005,14(5):373-375.doi:10.3969/j.issn.1005-6947.2005.05.016.
[18]胡元国,黄强.胰体尾癌的诊治:附4 5例报告[J].中国普通外科杂志,2 0 1 5,2 4(3):3 4 3-3 4 6.d o i:1 0.3 9 7 8/j.issn.1005-6947.2015.03.007.Hu YG,Huang Q.Diagnosis and treatment of carcinoma of pancreatic body and tail:a report of 45 cases[J].Chinese Journal of General Surgery,2015,24(3):343-346.doi:10.3978/j.issn.1005-6947.2015.03.007.
[19]戚峰,邰升.联合腹腔干切除的胰体尾癌根治术[J].中华肝脏外科手术学电子杂志,2017,6(3):168-171.doi:10.3877/cma.j.issn.2095-3232.2017.03.005.Qi F,Tai S.Combined resection of celiac trunk in radical resection of cancer of body and tail of pancreas[J].Chinese Journal of Hepatic Surgery,2017,6(3):168-171.doi:10.3877/cma.j.issn.2095-3232.2017.03.005.
[20]徐权斌,郭洪春,王磊,等.术前评估有手术切除可能性的38例胰体尾癌临床诊治分析[J].中华胰腺病杂志,2014,14(2):122-124.doi:10.3760/cma.j.issn.1674-1935.2014.02.017.Xu QB,Guo HC,Wang L,et al.Analysis of clinical diagnosis and treatment of 38 cases of cancer of body and tail of pancreas with preoperative assessment of possible surgical resection[J].Chinese Journal of Pancreatology,2014,14(2):122-124.doi:10.3760/cma.j.issn.1674-1935.2014.02.017.
[21]王曦滔,顾万清,王宏光.胰体尾癌根治性切除手术:现状及展望[J].中华肝胆外科杂志,2016,22(3):213-216.doi:10.3760/cma.j.issn.1007-8118.2016.03.021.Wang XT,Gu WQ,Wang HG.Radical surgery for adenocarcinoma of body and tail of pancreas:current status and future perspectives[J].Chinese Journal of Hepatobiliary Surgery,2016,22(3):213-216.doi:10.3760/cma.j.issn.1007-8118.2016.03.021.
[22]Sahakyan MA,Kazaryan AM,Rawashdeh M,et al.Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma:results of a multicenter cohort study on 196 patients[J].Surg Endosc,2016,30(8):3409-3418.doi:10.1007/s00464-015-4623-x.
[23]孙志鹏,朱昱冰,阿民布和,等.腹腔镜保脾胰体尾整块切除手术治疗胰腺癌的技术细节及预后[J].首都医科大学学报,2017,38(5):733-739.doi:10.3969/j.issn.1006-7795.2017.05.019.Sun ZP,Zhu YB,Amin BH,et al.Detail of the en-bloc technique and prognosis of spleen-preserving laparoscopic distal pancreatectomy for pancreatic cancer[J].Journal of Capital Medical University,2017,38(5):733-739.doi:10.3969/j.issn.1006-7795.2017.05.019.
[24]刘峥嵘.脾脏保留对胰体尾切除术治疗胰腺神经内分泌肿瘤预后的影响[J].中国普通外科杂志,2015,24(9):1241-1244.doi:10.3978/j.issn.1005-6947.2015.09.007.Liu ZR.Influence of spleen preservation on prognosis of patients with pancreatic neuroendocrine neoplasms following distal pancreatectomy[J].Chinese Journal of General Surgery,2015,24(9):1241-1244.doi:10.3978/j.issn.1005-6947.2015.09.007.
[25]Tang CW,Feng WM,Bao Y,et al.Spleen-preserving distal pancreatectomy or distal pancreatectomy with splenectomy?:Perioperative and patient-reported outcome analysis[J].J Clin Gastroenterol,2014,48(7):e62-66.doi:10.1097/MCG.0000000000000021.
[26]Panda N,Bansal NK,Narsimhan M,et al.Spleen-Preserving Versus Spleen-Sacrificing Distal Pancreatectomy in Laparoscopy and Open Method-Perioperative Outcome Analysis-14 Years Experience[J].Indian J Surg,2016,78(2):90-95.doi:10.1007/s12262-015-1324-6.
[27]Rehman S,John SK,Lochan R,et al.Oncological feasibility of laparoscopic distal pancreatectomy for adenocarcinoma:a singleinstitution comparative study[J].World J Surg,2014,38(2):476-483.doi:10.1007/s00268-013-2268-2.
[28]Sahin TT,Fujii T,Kanda M,et a1.Prognostic implications of lymph node metastases in carcinoma of the body and tail of the pancreas[J].Pancreas,2011,40(7):1029-1033.doi:10.1097/MPA.0b013e3182207893.
[29]Diener MK,Knaebel HP,Witte ST,et al.DISPACT trial:a randomized controlled trial to compare two different surgical techniques of DIStal PAnCreaTectomy-study rationale and design[J].Clin Trials,2008,5(5):534-545.doi:10.1177/1740774508096140.
[30]Matsushima H,Kuroki T,Adachi T,et a1.Laparoscopic spleenpreserving distal pancreatectomy with and without splenic vessel preservation:the role of the Warshaw procedure[J].Pancreatology,2014,14(6):530-535.doi:10.1016/j.pan.2014.09.007.