Clinical Retrospective Study On Laparoscopic Distal Pancreatectomy

Along with the progress made in medical science andtechnology, we have had a further and profound understanding ofthe relations between the anatomy related to spleen and itsfunctions including blood storing, hematopoiesis, hemofiltration,dispersing of blood stasis, immunoregulation, anti-infection,anti-tumor, endocrine as well as that between the spleen andrelevant diseases; it has been proven clinically that thepreservation of spleen can be conducive to enhancing theimmunologic function and lowering the possibility of postoperativeoverwhelming infections and also be of many other advantages.The researches made by Garrere, Shoup and other scholars havefully demonstrated that the incidence rate of complications such aspostoperative pancreatic fistula and bleeding can be decreaseddramatically by preserving the spleen; as a result, the surgicalmethods concerning preservation of spleen have been widelyapplied clinically.The Laparoscopic Spleen Preserving Distal Pancreatectomycan be classified as two categories: one is Kimura and the other isWarshaw. The head-up tile position is adopted in both of thesurgical methods mentioned above; four positions are selected forpunctures and establishing pneumoperitoneum in the two methods: belly button, midaxillary line parallel to belly button, below thexiphoid, left mid-clavicular line (margin under the spleen). As for theKimura type of Laparoscopic Spleen Preserving DistalPancreatectomy, the laparoscope is applied for probing in thesurgical operation; furthermore, the ultrasound knife is used to cutthe gastrocolic ligament, gastrosplenic ligament, splenocolicligament open and break off the short gastric vessels to make thedistal pancreas exposed. Besides, the atraumatic forceps is alsoutilized together to isolate the upper edge of pancreas anddissociate splenic artery. Then the lower edge and the back ofpancreas shall be separated; and the ultrasound knife is applied tocut open and coagulate the small vascular branches presentbetween the pancreas and the splenic artery/vein or make thevascular branches be cut open after the vascular clamp is appliedfor clipping. This enables the pancreas to be dissociated fromsurface of the main splenic artery/vein. Then such operations shallbe followed: lifting the neck of pancreas after the vascular sling isplaced in order to prompt the positioning of the distal pancreas;preserving the spleen and the main trunk of splenic artery/vein;lifting the pancreas up, dissociating the paries posterior of the neckof pancreas carefully along the paries of superior mesenteric vein;and separating the portal vein with the pancreatic parenchyma. The Endo—G1A is applied to separate the neck of pancreas. Thenplacing the distal pancreas into sample collection bag and takingout the sample from the opening of annular tubes. After thehemostasis is conducted on the wound, the broken end of pancreasshall be placed in a double catheterization cannula. As for theWarshaw type of Laparoscopic Spleen Preserving DistalPancreatectomy, such operations shall be followed: lifting thepancreas up, dissociating the neck of pancreas carefully along theparies of superior mesenteric vein and separating the portal veinwith the pancreatic parenchyma. Endo—G1A shall be applied toseparate the neck of pancreas; then the following steps shall betaken: lifting the distal end of pancreas up; dissociating thepancreatic parenchyma along the main trunk of splenic artery/vein;the absorbable clip is utilized to clip and separate the main trunk ofsplenic artery/vein; in this way, the risk of bleeding can be reduced.Then, dissociating the distal pancreas, clipping the splenicartery/vein branches at the hilum of spleen, preserving the shortgastric vessels and the left gastric omental vessel and cutting offthe distal pancreas tissues having pathological changes; andplacing the distal pancreas into sample collection bag and takingout the sample from the opening of annular tubes. After thehemostasis is conducted on the trauma, the broken end of pancreas shall be placed in a double catheterization cannula.According to the literatures and reports both at home and abroad,there is no explicit indication showing which kind of surgicalmethods shall be selected; the advantages and disadvantages ofthe two surgical methods mentioned above still remain to bestudied further.In recent years, as the technologies and facilities concerningthe laparoscope have developed in a constant manner, thesurgeons have a greater understanding of the pancreas, splenicanatomy as well as the physiological function. The laparoscopicdistal pancreatectomy has been increasingly applied clinically andthe surgical operations regarding it have become more and moremature. The ultimate goal of medical treatment is to cure themaximum illness of patients by adopting the surgical methods thatwould cause the minimum trauma to them and this is also theobjective of all the surgeons to pursue in their later work.