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目的探讨胰体尾脾脏切除的手术入路。方法回顾性分析我院2007年至2008年行胰体尾脾脏切除术36例患者的临床资料,其中16例采用逆行入路,20例采用常规入路。结果所有患者均成功完成逆行性胰体尾切除术,逆行入路组平均手术时间(80±14)min,术中平均出血150ml,患者术后恢复良好,术后平均住院时间(11±3.5)d,无胰漏及其他并发症发生。常规入路组平均手术时间(120±23)min,术中平均出血210ml,均未输血,患者术后恢复良好,术后平均住院时间(13±4.1)d,无胰漏及其他并发症发生,无新发糖尿病病例。对所有患者随访3～24个月,有2例分别存活6个月和11个月,其余患者健在。结论逆行入路胰体尾脾脏切除易控制门静脉、肠系膜上静脉,降低了门静脉、肠系膜上静脉脾脏动静脉损伤的可能;易控制脾脏动静脉,减少了出血量,降低了手术难度,缩短了手术时间,同时降低了肿瘤复发或转移的机会。
Objective To explore the surgical approach of pancreatic tail tail spleen resection. Methods The clinical data of 36 patients with pancreatic tail tail splenectomy from 2007 to 2008 in our hospital were analyzed retrospectively. Among them, 16 cases were treated retrogradely and 20 cases were routinely accepted. Results All patients underwent successful retrograde pancreatic body resection. The mean operative time (80 ± 14) min in the retrograde approach group was 150 ml. The average postoperative recovery was good and the average postoperative hospital stay was 11 ± 3.5. d, no pancreatic leakage and other complications. The average operation time (120 ± 23) min and average intraoperative blood loss of 210ml in the routine approach group were all lower than those in the normal group, and the patients recovered well after operation. The average postoperative hospital stay was (13 ± 4.1) days without any pancreatic leakage and other complications , No new cases of diabetes. All patients were followed up for 3 to 24 months. Two of them survived for 6 months and 11 months, respectively. The remaining patients were alive. Conclusions It is easy to control the portal vein and superior mesenteric vein by retrograde approach and pancreatic tail spleen to reduce the possibility of injury of portal vein and superior mesenteric vein. It is easy to control the arteriovenous and splenic vein and reduce the amount of bleeding, reducing the difficulty of operation and shortening the operation Time, while reducing the chance of tumor recurrence or metastasis.