中国实用外科杂志

中国实用外科杂志 ›› 2023, Vol. 43 ›› Issue (02): 206-210.DOI: 10.19538/j.cjps.issn1005-2208.2023.02.16

• 文献综述 • 上一篇    下一篇

保留脾脏的胰体尾切除术研究进展

徐建威，王    磊   

  1. 山东大学齐鲁医院普外科（胰腺外科），山东济南250012
  • 出版日期:2023-02-01 发布日期:2023-02-20

  • Online:2023-02-01 Published:2023-02-20

摘要： 保留脾脏的胰体尾切除术（SPDP）是一种保留脏器的成熟术式，腹腔镜或机器人辅助SPDP已在大型中心常规开展。 SPDP主要适用于胰体尾部良性或低度恶性病变，但是对于直径>2 cm的胰腺神经内分泌肿瘤应充分权衡脏器保留需求与肿瘤根治必要性。SPDP包括Kimura术和Warshaw术；亦有人实施保留脾动脉、牺牲脾静脉等改良术式，尚存争议。与Kimura术相比，Warshaw术后脾梗死及继发性脾切除发生率更高、胃周静脉曲张更常见。脾梗死一般无临床症状，无须干预，通过随访能够观察到梗死区域恢复血流灌注；继发性脾切除的手术指征不明确，但对于脾梗死合并脓肿的病例需积极干预。在SPDP术前规划方面，目前尚无高效的术式预测模型，基于脾静脉影像学分型及肿瘤直径的术前影像学评分模型有助于制定合理手术决策。在手术入路方面，随着腹腔镜及机器人辅助胰体尾切除术的发展，更多选择顺行切除，但逆行切除可优先探查保脾可行性，亦展现出一定价值。经过30余年发展，SPDP获益及风险基本明晰，但仍存在争议性议题亟待解决。

关键词: 保留脾脏的胰体尾切除术, 保留功能的胰腺手术, Kimura术, Warshaw术, 腹腔镜, 手术入路, 手术并发症

Abstract: Advances and viewpoints of spleen preserving distal pancreatectomy        XU Jian-wei, WANG Lei. Department of Pancreatic Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
Corresponding author: WANG Lei, E-mail:qlwanglei1102@163.com
Abstract    As an organ-sparing operation, spleen preserving distal pancreatectomy (SPDP) is commonly performed, even for laparoscopic and robotic-assisted procedures. SPDP is suitable for patients with benign or low-grade malignant lesions, but for >2 cm pancreatic neuroendocrine tumors (pNET), both organ-preservation and radical resection should be considered. SPDP includes Kimura and Warshaw procedures; some modified procedures, such as artery preservation with vein sacrifice, are also performed but not well accepted. Compared with Kimura procedure, a higher incidence of splenic infractions and secondary splenectomy and gastric varices is observed after Warshaw procedure. Patients with splenic infraction are always asymptomatic, poorly perfused areas will be restored perfusion after a few months without further therapy. Although the indication for secondary splenectomy in treatment of a splenic infraction is still unclear, cases with splenic abscesses need surgical intervention. There is no effective preoperative scoring system to create a spleen-preserving strategy. The scoring system that combines the tumor size and image classification of the splenic vein displayes a favor value in predicting SPDP procedures. The antegrade approach is preferred in the era of laparoscopic and robotic assisted distal pancreatectomy; however, a retrograde approach can be performed in some situations and indicates good outcomes due to preferentially dissecting the pancreatic tail and then making a decision of preserving or resecting the spleen in the early stage of operation. In short, the benefits and risks of SPDP are basically clear after more than 30 years of development, but there are still controversial issues to be resolved.

Key words: spleen preserving distal pancreatectomy, organ-sparing pancreatectomy, Kimura procedure, Warshaw procedure, laparoscope, surgical approach, surgical complication