Background

Several approaches have been reported during laparoscopic spleen-preserving distal pancreatectomy (LSPDP), such as medial, lateral, and posterior approaches. This study reports a tail-first approach that is mobilization of the pancreatic gland from tail to neck followed by division. The short-term outcomes are described.

Methods

Cases which underwent LSPDP from 2014 to 2020 at Qilu Hospital of Shandong University were included. Clinical parameters were collected and analyzed.

Results

One hundred five cases were collected, including 54 Kimura, 45 Warshaw, and 6 modified-Warshaw procedures. Seventy-seven patients (73.3%) underwent LSPDP by a tail-first approach (TFA-LSPDP) and 28 (26.7%) by a medial approach (M-LSPDP). Compared with the M-LSPDP, the TFA-LSPDP group had a lower incidence of splenic infraction (9.1 VS 25.0%, P = 0.05) and a higher frequency of Kimura procedure (55.8 VS 39.3%, P = 0.053).

Conclusion

TFA-LSPDP is feasible and safe for treatment of benign and low malignant lesions of the distal pancreas, which has a lower incidence of splenic infraction and a higher frequency of splenic vessel preservation compared with the traditional medial approach.

中文翻译：

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尾先入路在腹腔镜保脾远端胰腺切除术中的短期结果：单中心经验

背景

在腹腔镜保留脾脏的远端胰腺切除术 (LSPDP) 中已经报道了几种方法，例如内侧、外侧和后部方法。这项研究报告了一种尾部优先的方法，即从尾部到颈部动员胰腺，然后进行分裂。描述了短期结果。

方法

包括2014年至2020年在山东大学齐鲁医院接受LSPDP的病例。收集和分析临床参数。

结果

共收集到 105 个案例，包括 54 个木村、45 个 Warshaw 和 6 个改良的 Warshaw 程序。77 名患者 (73.3%) 通过尾部优先入路 (TFA-LSPDP) 和 28 名 (26.7%) 通过内侧入路 (M-LSPDP) 接受 LSPDP。与 M-LSPDP 相比，TFA-LSPDP 组脾脏梗死发生率较低（9.1 VS 25.0%，P  = 0.05），木村手术频率较高（55.8 VS 39.3%，P  = 0.053）。

结论

TFA-LSPDP治疗远端胰腺良性和低恶性病变是可行和安全的，与传统的内侧入路相比，其脾梗死发生率更低，保留脾血管的频率更高。