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目的:探讨Kimura法(腹腔镜下保留脾血管的胰体尾切除术)中脾血管分离的技术要点。方法:回顾性分析2015年1月—2016年12月采用Kimura法实施的18例胰腺体尾部切除患者的临床资料。结果:18例均顺利完成Kimura手术,手术时间136~220 min,平均170 min,出血量50~450 mL,平均180 mL,术后平均住院时间6~21 d,平均9.6 d,术后病理均为胰腺良性或交界性肿瘤。10例患者术中使用5-0的Prolene线缝合脾静脉或脾动脉裂口。术后主要并发症为腹腔胰瘘,其中A级胰瘘8例(44.4%),B级胰瘘2例(11.1%),均经保守治疗治愈。结论:Kimura法治疗胰体尾部良性及交界性肿瘤是安全可行的,完善的术前准备、娴熟的腔镜下操作技术和配合能力,尤其是掌握脾血管分离和缝合技巧是完成手术的关键。
Objective: To explore the technical points of spleen and blood vessel separation in Kimura method (laparoscopic pancreatic body excision of splenic vessels). Methods: The clinical data of 18 patients with pancreatic body excision performed by Kimura method from January 2015 to December 2016 were retrospectively analyzed. Results All patients underwent Kimura operation successfully. The operation time ranged from 136 to 220 minutes, with an average of 170 minutes. The bleeding amount was from 50 to 450 mL (average 180 mL). The average postoperative hospital stay was from 6 to 21 days (mean, 9.6 days) For benign or borderline tumors of the pancreas. Ten patients underwent 5-0 Prolene suturing of the splenic or splenic artery. The main complication after operation was celiac pancreatic fistula, including 8 cases (44.4%) of grade A pancreatic fistula and 2 cases (11.1%) of grade B pancreatic fistula, all of which were cured by conservative treatment. Conclusion: The Kimura method is safe and feasible for the treatment of benign and borderline tumors of the pancreatic body and tail, perfect preoperative preparation, skilled endoscopic operative technique and cooperative ability, especially the master of splenic blood vessel separation and suture technique is the key to complete the operation.