Clinical Curative Effect Research Of Laparoscopic Spleen-preserving Distal Pancreatectomy

Objective:To explore the feasibility, security and advantages of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for lesions in pancreatic body and tail.Materials and Methods:A total of 42 patients with occupancy lesions in pancreatic body and tail who underwent laparoscopic distal pancreatectomy in Qilu hospital from October 2009 to October 2015 were collected and analyzed retrospectively. Two groups were divided into LSPDP group (n=22) and laparoscopic distal pancreatectomy with splenectomy (LDPS) group (n=20) according to the operation procedure. Operation duration, blood loss, postoperative hospital stay, pathology, size of tumor, complications and platelet changes of these two groups were collected and statistically analyzed.Results:General information (age, sex) of two groups of patients did not have significance difference (P> 0.05),which were comparable. The operations got well in all patients, no one died during perioperative period. Among 22 patients in LSPDP group,15(15/22) with Kimura procedure,5(5/22) with Warshaw procedure. Splenic artery was cut off with conservation of spleen vein in 1(1/22) patient while splenic vein was cut off witn conservation of splenic artery in 1 (1/22) patient. And There was no significant difference between LSPDP group and LDPS group in the operation time, blood loss, postoperative hospital stay. There was significant difference between LSPDP group and LDPS group in the average postoperative fasting time (P <0.05). About the pathology, LSPDP versus LDPS, PEN 9 versus 4, SPN 6 versus 1, MCN2 versus 4, SCN 2 versus 0, pancreatic cyst 3 versus 4, pancreatic cancer 0 versus 5. Pancreatic fistula occurred in 5 patients (5/22) of LSPDP group while 3 (3/22) of LDPS group, and were cured by non-operative treatment. Platelet (PLT) for the patients of LDPS increased in different degrees, up to 461*10^9/L and were resumed the normal rang after oral administration of aspirin. For the patients of LSPDP group postoperative platelet change is not obvious.Conclusion:For occupancy lesions in pancreatic body and tail, LSPDP is feasible and safe, therefore,worthy of clinical popularization. During the operation, we should pay attention to the treatment of splenic vessels and the prevention and treatment of pancreatic fistula.