LAPAROSCOPIC DISTAL PANCREATECTOMY WITH SPLEEN PRESERVATION

ABSTRACT Background: Laparoscopic distal pancreatectomy has been the choice for resection of distal pancreas lesions due many advantages over open approach. Spleen preservation technique seems minimizes infectious complications in long-term outcome. Aim: To present the results of laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique (preservation of spleen blood vessels) performed by single surgical team. Methods: Retrospective case series aiming to evaluate both short and long-term outcomes of laparoscopic distal pancreatectomies with spleen preservation. Results: A total of 54 laparoscopic distal pancreatectomies were performed, in which 26 were laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique. Mean age was 47.9 years-old (21-75) where 61.5% were female. Mean BMI was 28.5 kg/m² (18-38.8). Mean diameter of lesion was 4.3 cm (1.8-7.5). Mean operative time was 144.1 min (90-200). Intraoperative bleeding was 119.2 ml (50-600). Conversion to laparotomy 3% (n=1). Postoperative morbidity was 11.5%. Postoperative mortality was null. Mean of hospital stay was 4.8 days (2-14). Mean time of follow-up period was 19.7 months (2-60). There was no neoplasm recurrence or mortality on evaluated period. There was no infectious complication. Conclusion: Laparoscopic distal pancreatectomy with spleen and splenic vessels preservation is feasible, safe, and effective procedure. This technique presented both low morbidity and null mortality on this sample. There were neither infectious complications nor neoplasm recurrence on long-term follow-up period.

摘要
背景：腹腔镜远端胰腺切除术相较于开放手术具有诸多显著优势，现已成为远端胰腺病变切除的首选术式。脾脏保留技术可改善患者长期预后，降低感染性并发症的发生风险。
目的：报道由单个手术团队采用Kimura术式（保留脾脏血管）实施腹腔镜远端胰腺切除术联合脾脏保留的临床结果。
方法：本研究为回顾性病例系列研究，旨在评估腹腔镜远端胰腺切除术联合脾脏保留的短期与长期预后情况。
结果：本中心共完成54例腹腔镜远端胰腺切除术，其中26例采用Kimura术式行腹腔镜远端胰腺切除术联合脾脏保留。患者平均年龄为47.9岁（年龄范围21~75岁），女性占比61.5%；平均体质量指数（Body Mass Index, BMI）为28.5kg/m²（范围18~38.8kg/m²）；病变平均直径4.3cm（范围1.8~7.5cm）；平均手术时长144.1min（范围90~200min）；术中平均失血量119.2ml（范围50~600ml）；中转开腹率为3%（n=1）；术后并发症发生率为11.5%；无术后死亡病例。平均住院时长4.8天（范围2~14天）；平均随访时长19.7个月（范围2~60个月）。随访期间未出现肿瘤复发或死亡病例，亦未发生感染性并发症。
结论：采用Kimura术式的腹腔镜远端胰腺切除术联合脾脏及脾血管保留是一种可行、安全且有效的手术方案。本研究队列中该术式并发症发生率低、无术后死亡病例，长期随访期间未出现感染性并发症及肿瘤复发。