Résumé
Objective To study the surgical treatment strategies,techniques and results of laparoscopic surgery for space occupying lesions in pancreatic body and tail.Methods To retrospectively analyze the clinical data of 65 patients with space occupying lesions in pancreatic body and tail.These patients were consecutively treated in Department of Minimally Invasive Surgery,the First Affiliated Hospital of Zhengzhou University from January 2010 to November 2017.Results All operations on the 65 patients were performed laparoscopically.The operations included laparoscopic distal pancreatectomy with splenectomy (n =22),spleen preserving laparoscopic distal pancreatectomy (n =43,with Kimura's method,n =38;and Warshaw's method,n =5).The mean size of the lesions was 5.5 cm (range 1.0 ～ 11.2 cm).The mean intraoperative blood loss was 120 ml (range 30～350 ml).The mean operation time was 230 min (range 160～310 min).Complications developed in 11 patients (16.9％).There were no tumour recurrence on follow-up which ranged from 1 to 81 months.Conclusions For patients with space occupying lesions in pancreatic body and tail,surgical strategies should be planned according to the site of the lesion and its relation to the blood vessels of the spleen.With good surgical techniques,laparoscopic treatment of lesions in pancreatic body and tail can be carried out safely,with a low complication rate and with an increased spleen preservation rate.
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Objective To discuss the diagnosis and laparoscopic treatment for superior mesenteric artery compressing syndrome (SMACS).Methods A retrospective analysis was conducted on 62 SMACS patients who had received total laparoscopy treatment from October 2006 to May 2016.Results All 62 cases received upper gastrointestinal series and definite diagnosis was achieved on 51 cases;Definite diagnosis was made on 31 cases among 44 cases undergoing CTA (CTA,CT angiography) examination,19 cases were diagnosed with the disease among 26 cases who had received ultrasound examination.Total laparoscopic duodenojejunostomy was conducted on 41 cases,total laparoscopic gastrointestinal anastomosis was conducted on 14 cases,total laparoscopic gastroduodenal double shortcut anastomosis was conducted on 7 cases.All patients were cured or alleviated and discharged from hospital.Conclusions Upper GI contrast series made definite diagnosis on most SMACS cases.For patients with relapsing symptoms and poor conservative treatment result a surgery is recommended.Total laparoscopic duodenojejunostomy is the mainstay of treatment and is safe and reliable.
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Objective To discuss the diagnosis and laparoscopic treatment for superior mesenteric artery compressing syndrome (SMACS).Methods A retrospective analysis was conducted on 62 SMACS patients who had received total laparoscopy treatment from October 2006 to May 2016.Results All 62 cases received upper gastrointestinal series and definite diagnosis was achieved on 51 cases;Definite diagnosis was made on 31 cases among 44 cases undergoing CTA (CTA,CT angiography) examination,19 cases were diagnosed with the disease among 26 cases who had received ultrasound examination.Total laparoscopic duodenojejunostomy was conducted on 41 cases,total laparoscopic gastrointestinal anastomosis was conducted on 14 cases,total laparoscopic gastroduodenal double shortcut anastomosis was conducted on 7 cases.All patients were cured or alleviated and discharged from hospital.Conclusions Upper GI contrast series made definite diagnosis on most SMACS cases.For patients with relapsing symptoms and poor conservative treatment result a surgery is recommended.Total laparoscopic duodenojejunostomy is the mainstay of treatment and is safe and reliable.
Résumé
ObjectiveTo study the feasibility of laparoscopic assisted splenectomy for massive splenomegaly and devascularization in the treatment of patients with cirrhosis and portal hypertension.MethodA retrospective study was carried out on 12 patients who underwent laparoscopic assisted splenectomy and devascularization from October 2003 to January 2010.ResultsThe operation was successfully carried out in eight patients.The remaining four patients were converted to open surgery due to intra-operative bleeding.The mean operation times for the 12 patients and the 8 patients who underwent laparoscopic surgery were 350 min (range,190-470 min) and 313 min (range,190-410 min),respectively.The corresponding mean intra-operative blood losses were 1300 ml (range,200-2200 ml) and 700 ml (range,200-1700 ml),respectively.For the 8 patients who received laparoscopic surgery,flatus were passed 3-5 days after operation,and the postoperative hospitalization was 10-20 days.ConclusionsLaparoscopic assisted splenectomy for massive splenomegaly and devascularization is feasible.It is a treatment option for patients with cirrhosis and portal hypertension.