Laparoscopic Spleen-preserving Distal Pancreatectomy:28Cases Analysis

Objective:To analysis the clinical data of laparoscopic spleen-preserving distal pancreatectomy(LSPDP), to summarize the application and operation tips of LSPDP.Methods:The clinical data of28patients who had a laparoscopic spleen-preserving distal pancreatectomy in the Sir Run Run Shaw Hospital of Zhejiang University during2003November to2013February were analyzed retrospectively. Statistical analysis the patient’s sex, age, preoperative complications, operation time, intraoperative blood loss, postoperative complications, postoperative hospital stay, postoperative pathological results.Results:All of the28cases were completed successfully in the laparoscopic, without conversions to open surgery, including3cases with cholecystectomy,l case with resection of right adrenal tumor,1case with myomectomy and left ovarian teratoma resection,1case with resection of left lateral lobe of liver and choledocholithotomy. The mean operation time was120.81±50.33min(70-320min), the mean intraoperative blood loss was80.82±43.12ml(50-300ml),and the mean postoperative hospital stay was7.61±4.23d(5-19d).The rate of overall postoperative complication was14.2%(4/28) including an10.7%rate of clinical pancreatic fistula. The postoperative pathological diagnosis:16cases of benign pancreatic disease (2cases of pancreatic retention cyst,4cases of, pancreatic epithelial cyst,1case of congenital cyst of pancreas,8cases of pancreatic serous cystadenoma,1case with insulinoma),12cases of borderline or low-grade malignant lesions (7cases of pancreatic mucinous cystadenoma,3cases of pancreatic solid-pseudopapillary tumors,1case of well-differentiated neuroendocrine tumors,1case of pancreatic intraductal papillary mucinous adenoma). All patient’s symptoms disappeared after operation and no recurrence was observed during the follow up period ranged from6to96months.Conclusions:Laparoscopic spleen-preserving distal pancreatectomy is the suitable for the distal pancreatic benign or low-grade malignant lesions. LSPDP has a certain significance for the diagnosis and differential diagnosis of the distal pancreatic cystic tumor. Preservation of the spleen vessels(Kimura method) can be the first choice method for LSPDP. Under special conditions, cut off the spleen vessels can also be consided.