Discussion and clinical application experience of laparoscopic spleen-preserving distal pancreatectomy technology_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Xiaopeng ^1,2 , XU Jian ^1,2 , WU Changkang ¹ , QUAN Gang ¹ , LI Qiang ¹ , YANG Gang ¹ , XIONG Yongfu ^1,2 , LI Jiangpeng ² , WU Guo ^1,2 ,  LI Jingdong ^1,2

1. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
2. Institute of Hepatobiliary-Pancreatic-Intestinal Diseases, North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

LI Jingdong, Email: lijingdong358@126.com

Keywords：

laparoscopic spleen-preserving distal pancreatectomy; feasibility; safety

DOI：

10.7507/1007-9424.202005091

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the key technical points, applicability, feasibility, and safety of laparoscopic spleen-preserving distal pancreatectomy (LSPDP).Method A retrospective analysis was performed for the clinical data of 22 patients who were admitted to the Affiliated Hospital of North Sichuan Medical College from September 2016 to November 2019, all patients planned to receive LSPDP.Results Twenty of the 22 patients successfully completed LSPDP, and 2 patients converted to laparotomy. One patient was transferred to laparotomy to suture the damaged splenic artery. The spleen was observed to have no ischemia and the spleen preservation operation was continued. One patient was converted to laparotomy due to the difficulty of dissecting the tail of the pancreas which caused by severe abdominal adhesion. The operation time of LSPDP patients was (191±86) minutes (170–480 min), intraoperative blood loss was (365±50) mL (200–1 000 mL), and postoperative hospital stay was (9.9±2.6) days (7–16 d). Six patients of pancreatic fistula occurred after operation, including 3 cases of biochemical fistula, which were cured and discharged after symptomatic treatment, 3 cases of grade B pancreatic fistula, who all improved after anti-inflammatory, acid suppression, enzyme suppression, and double catheter drainage. Twenty patients were interviewed after the operation, and the follow-up time was 3–24 months (median of 15 months). During the follow-up period, no patient had recurrence or metastasis.Conclusions Under the conditions of strict screening of suitable cases, adequate preoperative imaging evaluation, intraoperative fine manipulation, and the application of appropriate operating instruments and cutting closure devices, LSPDP is safe and feasible to treat benign tumors of the pancreatic body and tail and some borderline tumors. During the operation, attention should be paid to the reasonable treatment and protection of splenic arteries and veins.

Citation： LIU Xiaopeng, XU Jian, WU Changkang, QUAN Gang, LI Qiang, YANG Gang, XIONG Yongfu, LI Jiangpeng, WU Guo, LI Jingdong. Discussion and clinical application experience of laparoscopic spleen-preserving distal pancreatectomy technology. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(2): 189-193. doi: 10.7507/1007-9424.202005091 Copy

1.	李维坤, 郭春光, 田艳涛. 腹腔镜保留脾血管胰体尾切除术临床体会. 中华腔镜外科杂志 (电子版), 2019, 12(4): 203-206.
2.	李中辉, 陈华, 陈宏泽, 等. 腹腔镜保留脾脏胰体尾切除术17例报道. 中国普外基础与临床杂志, 2018, 25(8): 929-933.
3.	罗家庆, 蔡涵晖, 吴伟顶, 等. 脾血管优先技术在腹腔镜保留脾脏胰体尾切除术中的应用. 肝胆胰外科杂志, 2018, 30(5): 417-419.
4.	Huang J, Yadav DK, Xiong C, et al. Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) versus open spleen-preserving distal pancreatectomy (OSPDP): a comparative study. Can J Gastroenterol Hepatol, 2019, 2019: 9367868.
5.	丁轶人, 江涌, 赵伟, 等. 腹腔镜治疗胰体尾良性与低度恶性肿瘤的临床体会. 腹腔镜外科杂志, 2020, 25(5): 368-373.
6.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
7.	中华医学会外科学分会脾功能与脾脏外科学组. 保留脾脏胰腺远端切除术专家共识. 中国实用外科杂志, 2014, 34(1): 6-9.
8.	严辉弟, 周立新, 王茂林, 等. 腹腔镜与开腹保留脾脏的胰腺远端切除术的临床对比研究. 腹腔镜外科杂志, 2019, 24(2): 103-106.
9.	Tsiouris A, Cogan CM, Velanovich V. Distal pancreatectomy with or without splenectomy: comparison of postoperative outcomes and surrogates of splenic function. HPB (Oxford), 2011, 13(10): 738-744.
10.	Mebius RE, Kraal G. Structure and function of the spleen. Nat Rev Immunol, 2005, 5(8): 606-616.
11.	王浩炜, 吴浩荣, 刘根寿, 等. 自体脾移植术后血液流变学指标的临床观察. 中国血液流变学杂志, 2001, 11(2): 107-108.
12.	Lai W, Lu SC, Li GY, et al. Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization. World J Gastroenterol, 2012, 18(26): 3443-3450.
13.	戴朝六, 徐锋, 金添强. 重视门静脉高压症脾切除断流术后门静脉系统血栓的诊治. 中华普通外科学文献(电子版), 2019, 13(3): 169-174.
14.	李航. 腹腔镜脾切除术的临床应用进展. 河北医科大学学报, 2020, 41(3): 354-358.
15.	Tahir F, Ahmed J, Malik F. Post-splenectomy sepsis: a review of the literature. Cureus, 2020, 12(2): e6898.
16.	Kimura W, Inoue T, Futakawa N, et al. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery, 1996, 120(5): 885-890.
17.	Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg, 1988, 123(5): 550-553.
18.	Jean-Philippe Adam, Alexandre Jacquin, Christophe Laurent, et al. Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg, 2013, 148(3): 246-252.
19.	杨尹默, 高红桥, 庄岩, 等. 腹腔镜保留脾脏胰体尾切除术的关键技术. 中华普外科手术学杂志 (电子版), 2019, 13(4): 332-335.
20.	杨培, 曾新桃, 罗华, 等. 腹腔镜保留与不保留脾脏的胰体尾切除术治疗胰体尾病变的效果分析. 腹腔镜外科杂志, 2019, 24(5): 328-332.
21.	Yu X, Li H, Jin C, et al. Splenic vessel preservation versus Warshaw’s technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review. Langenbecks Arch Surg, 2015, 400(2): 183-191.
22.	戴存才, 苗毅, 刘训良, 等. 保留脾和脾动静脉的胰体尾切除体会. 中华肝胆外科杂志, 2008, 14(8): 577-578.
23.	Cečka F, Jon B, Subrt Z, et al. Surgical technique in distal pancreatectomy: a systematic review of randomized trials. Biomed Res Int, 2014, 2014: 482906.
24.	Song SH, Kim HJ, Park EK, et al. Comparison of laparoscopic versus open distal pancreatectomy for benign, pre-malignant, and low grade malignant pancreatic tumors. Ann Hepatobiliary Pancreat Surg, 2020, 24(1): 57-62.
25.	李庆, 侯花屏. 胰体尾局部病变患者腹腔镜保留脾脏的胰体尾切除术的可行性研究. 中华普外科手术学杂志 (电子版), 2020, 14(2): 197-200.

1. 李维坤, 郭春光, 田艳涛. 腹腔镜保留脾血管胰体尾切除术临床体会. 中华腔镜外科杂志 (电子版), 2019, 12(4): 203-206.
2. 李中辉, 陈华, 陈宏泽, 等. 腹腔镜保留脾脏胰体尾切除术17例报道. 中国普外基础与临床杂志, 2018, 25(8): 929-933.
3. 罗家庆, 蔡涵晖, 吴伟顶, 等. 脾血管优先技术在腹腔镜保留脾脏胰体尾切除术中的应用. 肝胆胰外科杂志, 2018, 30(5): 417-419.
4. Huang J, Yadav DK, Xiong C, et al. Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) versus open spleen-preserving distal pancreatectomy (OSPDP): a comparative study. Can J Gastroenterol Hepatol, 2019, 2019: 9367868.
5. 丁轶人, 江涌, 赵伟, 等. 腹腔镜治疗胰体尾良性与低度恶性肿瘤的临床体会. 腹腔镜外科杂志, 2020, 25(5): 368-373.
6. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
7. 中华医学会外科学分会脾功能与脾脏外科学组. 保留脾脏胰腺远端切除术专家共识. 中国实用外科杂志, 2014, 34(1): 6-9.
8. 严辉弟, 周立新, 王茂林, 等. 腹腔镜与开腹保留脾脏的胰腺远端切除术的临床对比研究. 腹腔镜外科杂志, 2019, 24(2): 103-106.
9. Tsiouris A, Cogan CM, Velanovich V. Distal pancreatectomy with or without splenectomy: comparison of postoperative outcomes and surrogates of splenic function. HPB (Oxford), 2011, 13(10): 738-744.
10. Mebius RE, Kraal G. Structure and function of the spleen. Nat Rev Immunol, 2005, 5(8): 606-616.
11. 王浩炜, 吴浩荣, 刘根寿, 等. 自体脾移植术后血液流变学指标的临床观察. 中国血液流变学杂志, 2001, 11(2): 107-108.
12. Lai W, Lu SC, Li GY, et al. Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization. World J Gastroenterol, 2012, 18(26): 3443-3450.
13. 戴朝六, 徐锋, 金添强. 重视门静脉高压症脾切除断流术后门静脉系统血栓的诊治. 中华普通外科学文献(电子版), 2019, 13(3): 169-174.
14. 李航. 腹腔镜脾切除术的临床应用进展. 河北医科大学学报, 2020, 41(3): 354-358.
15. Tahir F, Ahmed J, Malik F. Post-splenectomy sepsis: a review of the literature. Cureus, 2020, 12(2): e6898.
16. Kimura W, Inoue T, Futakawa N, et al. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. Surgery, 1996, 120(5): 885-890.
17. Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg, 1988, 123(5): 550-553.
18. Jean-Philippe Adam, Alexandre Jacquin, Christophe Laurent, et al. Laparoscopic spleen-preserving distal pancreatectomy: splenic vessel preservation compared with the Warshaw technique. JAMA Surg, 2013, 148(3): 246-252.
19. 杨尹默, 高红桥, 庄岩, 等. 腹腔镜保留脾脏胰体尾切除术的关键技术. 中华普外科手术学杂志 (电子版), 2019, 13(4): 332-335.
20. 杨培, 曾新桃, 罗华, 等. 腹腔镜保留与不保留脾脏的胰体尾切除术治疗胰体尾病变的效果分析. 腹腔镜外科杂志, 2019, 24(5): 328-332.
21. Yu X, Li H, Jin C, et al. Splenic vessel preservation versus Warshaw’s technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review. Langenbecks Arch Surg, 2015, 400(2): 183-191.
22. 戴存才, 苗毅, 刘训良, 等. 保留脾和脾动静脉的胰体尾切除体会. 中华肝胆外科杂志, 2008, 14(8): 577-578.
23. Cečka F, Jon B, Subrt Z, et al. Surgical technique in distal pancreatectomy: a systematic review of randomized trials. Biomed Res Int, 2014, 2014: 482906.
24. Song SH, Kim HJ, Park EK, et al. Comparison of laparoscopic versus open distal pancreatectomy for benign, pre-malignant, and low grade malignant pancreatic tumors. Ann Hepatobiliary Pancreat Surg, 2020, 24(1): 57-62.
25. 李庆, 侯花屏. 胰体尾局部病变患者腹腔镜保留脾脏的胰体尾切除术的可行性研究. 中华普外科手术学杂志 (电子版), 2020, 14(2): 197-200.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Discussion and clinical application experience of laparoscopic spleen-preserving distal pancreatectomy technology

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content