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：

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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.	李維坤, 郭春光, 田艷濤. 腹腔鏡保留脾血管胰體尾切除術臨床體會. 中華腔鏡外科雜志 (電子版), 2019, 12(4): 203-206.
2.	李中輝, 陳華, 陳宏澤, 等. 腹腔鏡保留脾臟胰體尾切除術17例報道. 中國普外基礎與臨床雜志, 2018, 25(8): 929-933.
3.	羅家慶, 蔡涵暉, 吳偉頂, 等. 脾血管優先技術在腹腔鏡保留脾臟胰體尾切除術中的應用. 肝膽胰外科雜志, 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.	丁軼人, 江涌, 趙偉, 等. 腹腔鏡治療胰體尾良性與低度惡性腫瘤的臨床體會. 腹腔鏡外科雜志, 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.	中華醫學會外科學分會脾功能與脾臟外科學組. 保留脾臟胰腺遠端切除術專家共識. 中國實用外科雜志, 2014, 34(1): 6-9.
8.	嚴輝弟, 周立新, 王茂林, 等. 腹腔鏡與開腹保留脾臟的胰腺遠端切除術的臨床對比研究. 腹腔鏡外科雜志, 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.	王浩煒, 吳浩榮, 劉根壽, 等. 自體脾移植術后血液流變學指標的臨床觀察. 中國血液流變學雜志, 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, 徐鋒, 金添強. 重視門靜脈高壓癥脾切除斷流術后門靜脈系統血栓的診治. 中華普通外科學文獻(電子版), 2019, 13(3): 169-174.
14.	李航. 腹腔鏡脾切除術的臨床應用進展. 河北醫科大學學報, 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.	楊尹默, 高紅橋, 莊巖, 等. 腹腔鏡保留脾臟胰體尾切除術的關鍵技術. 中華普外科手術學雜志 (電子版), 2019, 13(4): 332-335.
20.	楊培, 曾新桃, 羅華, 等. 腹腔鏡保留與不保留脾臟的胰體尾切除術治療胰體尾病變的效果分析. 腹腔鏡外科雜志, 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, 劉訓良, 等. 保留脾和脾動靜脈的胰體尾切除體會. 中華肝膽外科雜志, 2008, 14(8): 577-578.
23.	Ce?ka 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.	李慶, 侯花屏. 胰體尾局部病變患者腹腔鏡保留脾臟的胰體尾切除術的可行性研究. 中華普外科手術學雜志 (電子版), 2020, 14(2): 197-200.

1. 李維坤, 郭春光, 田艷濤. 腹腔鏡保留脾血管胰體尾切除術臨床體會. 中華腔鏡外科雜志 (電子版), 2019, 12(4): 203-206.
2. 李中輝, 陳華, 陳宏澤, 等. 腹腔鏡保留脾臟胰體尾切除術17例報道. 中國普外基礎與臨床雜志, 2018, 25(8): 929-933.
3. 羅家慶, 蔡涵暉, 吳偉頂, 等. 脾血管優先技術在腹腔鏡保留脾臟胰體尾切除術中的應用. 肝膽胰外科雜志, 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. 丁軼人, 江涌, 趙偉, 等. 腹腔鏡治療胰體尾良性與低度惡性腫瘤的臨床體會. 腹腔鏡外科雜志, 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. 中華醫學會外科學分會脾功能與脾臟外科學組. 保留脾臟胰腺遠端切除術專家共識. 中國實用外科雜志, 2014, 34(1): 6-9.
8. 嚴輝弟, 周立新, 王茂林, 等. 腹腔鏡與開腹保留脾臟的胰腺遠端切除術的臨床對比研究. 腹腔鏡外科雜志, 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. 王浩煒, 吳浩榮, 劉根壽, 等. 自體脾移植術后血液流變學指標的臨床觀察. 中國血液流變學雜志, 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, 徐鋒, 金添強. 重視門靜脈高壓癥脾切除斷流術后門靜脈系統血栓的診治. 中華普通外科學文獻(電子版), 2019, 13(3): 169-174.
14. 李航. 腹腔鏡脾切除術的臨床應用進展. 河北醫科大學學報, 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. 楊尹默, 高紅橋, 莊巖, 等. 腹腔鏡保留脾臟胰體尾切除術的關鍵技術. 中華普外科手術學雜志 (電子版), 2019, 13(4): 332-335.
20. 楊培, 曾新桃, 羅華, 等. 腹腔鏡保留與不保留脾臟的胰體尾切除術治療胰體尾病變的效果分析. 腹腔鏡外科雜志, 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, 劉訓良, 等. 保留脾和脾動靜脈的胰體尾切除體會. 中華肝膽外科雜志, 2008, 14(8): 577-578.
23. Ce?ka 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. 李慶, 侯花屏. 胰體尾局部病變患者腹腔鏡保留脾臟的胰體尾切除術的可行性研究. 中華普外科手術學雜志 (電子版), 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

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