黄罗顺 周显飞 张阳 聂寒秋

[摘要] 目的 研究腹腔鏡保脾胰体尾整块切除手术治疗早期胰体尾癌患者肿瘤学预后及并发症研究。 方法 回顾性分析2010年1月至2019年1月台州市立医院接诊的100例胰体尾癌者的临床资料。按照手术方法分为研究组与对照组，每组各50例。对照组行腹腔镜胰体尾整块切除手术（LDPS），研究组行腹腔镜保脾胰体尾整块切除手术（LSPDP）。比较两组患者的围手术期指标与实验室指标，术后并发症发生率与术后长期预后情况。 结果 研究组患者术中出血量、手术时间、术中输血率、住院时间与对照组比较，差异无统计学意义（P>0.05）。研究组患者术后1 d与术后7 d的白细胞水平、中性粒细胞比例，术后1、3 d腹水淀粉酶水平与对照组水平比较，差异无统计学意义（P>0.05）;研究组术后2周、术后3个月的血小板水平与对照组相比明显升高（P<0.05）。观察组患者术后总并发症发生率与对照组比较，差异有统计学意义（P<0.05）。在5年期内的观察结果显示，研究组患者的平均的生存时间、1、3、5年的生存率、术后复发率、平均的复发时间、1、3、5年的无复发生存率与对照组比较，差异无统计学意义（P>0.05）。 结论 腹腔镜保脾胰体尾切除手术在治疗Ⅰ期、Ⅱ期胰体尾癌患者方面是一项有效且安全的手术技术，能够有效控制术后并发症发生率，值得推广运用。

[关键词] 胰体尾癌;腹腔镜;保脾胰体尾整块切除术;并发症

[中图分类号] R735.8          [文献标识码] B          [文章编号] 1673-9701（2021）32-0059-04

[Abstract] Objective To study the tumor prognosis and complications of laparoscopic spleen-preserving distal pancreatectomy in the treatment of patients with early pancreatic tail cancer. Methods The clinical data of 100 patients with pancreatic body and tail cancer admitted to Taizhou Municipal Hospital from January 2010 to January 2019 were analyzed retrospectively.The patients were divided into study group and control group according to surgical methods， with 50 cases in each group. The control group underwent laparoscopic distal pancreatectomy surgery （LDPS）， and the study group underwent laparoscopic spleen-preserving distal pancreatectomy （LSPDP）. Perioperative parameters，laboratory parameters， the incidence of postoperative complications，and long-term postoperative prognosis were compared between the two groups. Results There was no significant difference in intraoperative blood loss， operation time， intraoperative blood transfusion rate， and hospital stay between the study group and control group（P>0.05）. The white blood cell level and the neutrophil ratio at 1 d and 7 d after operation， and ascites amylase level at one day and three days after operation in the study group were not significantly different from those in the control group（P>0.05）. The platelet level at two weeks and three months after operation in the study group was significantly increased compared with that in the control group（P<0.05）.There was a significant difference in the incidence rate of total postoperative complications between the study group and the control group（P<0.05）. The observation results within five years showed that there were no significant differences in the average survival time，1，3，and 5-year survival rates， postoperative recurrence rate， average recurrence time and 1，3，5-year recurrence-free survival between the study group and the control group（P>0.05）. Conclusion Laparoscopic spleen-preserving distal pancreatectomy is an effective and safe surgical technique in treating patients with stage I and II pancreatic tail cancer， which can effectively control the incidence of postoperative complications and is worthy of being widely popularized.

[Key words] Pancreatic body and tail cancer; Laparoscopy; Laparoscopic spleen-preserving distal pancreatectomy; Complications

腹腔镜胰体尾手术在近20年历经了较大的发展与变化，从最初的个别案例报道，逐渐发展到标本活检、腹腔镜探查、胰体尾切除与胰十二指肠切除等。……