Twenty-Three Years of the Warshaw Operation for Distal Pancreatectomy With Preservation of the Spleen
Twenty-Three Years of the Warshaw Operation for Distal Pancreatectomy With Preservation of the Spleen
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DOI：
10.1097/sla.0b013e318212c1e2
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发表时间：
2011-06-01
影响因子：
9
通讯作者：
Warshaw, Andrew L.
中科院分区：
文献类型：
--
作者：
Ferrone, Cristina R.;Konstantinidis, Ioannis T.;Warshaw, Andrew L.
目的：描述我们的一系列远端胰腺切除术保留脾脏利用Warshaw操作，重点是可能的长期并发症，由于胃静脉曲张的发展。背景：Warshaw操作首次描述于1988年。方法：回顾性分析1986年2月至2009年2月间721例胰体尾切除术患者的临床资料。结果：经Warshaw手术保留脾脏158例（22%）。中位年龄为55岁（范围10-85岁），72%为女性。病理包括：35例粘液性囊性肿瘤（腺瘤28例，交界性7例），22例导管内乳头状粘液性肿瘤（腺瘤9例，交界性9例，癌4例），23例浆液性囊腺瘤，13例其他胰腺囊肿，27例胰腺内分泌肿瘤，16例慢性胰腺炎，9例导管腺癌和13例其他病理。仅3例（1.9%）患者在术后3 - 100天因腹痛和/或发热因脾梗死需要再次手术。中位随访时间为2.7年（平均4.5年，范围0-21年）。65例患者中有16例（25%）有胃周静脉曲张的证据，随访成像的中位数为3.4年，但没有158例患者发生消化道出血或脾功能亢进。结论：保脾Warshaw手术的术后失败率低，为1.9%。在25%的患者中发现了无症状性胃周静脉曲张的放射学证据。在长达21年的随访期间，任何患者均未发生胃周静脉曲张的临床后果。
Objective: To describe our series of distal pancreatectomies with preservation of the spleen utilizing the Warshaw operation with a focus on possible long-term complications due to the development of gastric varices.Background: The Warshaw operation was first described in 1988. The splenic vessels are resected and the spleen survives via the short gastric and left gastroepiploic vessels.Methods: Retrospective review of 721 patients who underwent a distal pancreatectomy between February 1986 and February 2009.Results: The spleen was preserved via the Warshaw operation in 158 patients (22%). Median age was 55 years (range 10-85) and 72% were females. Pathologies included: 35 mucinous cystic neoplasms (adenoma 28, borderline 7), 22 intraductal papillary mucinous neoplasms (adenoma 9, borderline 9, cancer 4), 23 serous cystadenomas, 13 other pancreatic cysts, 27 pancreatic endocrine tumors, 16 chronic pancreatitis, 9 ductal adenocarcinomas, and 13 other pathologies. Only 3 (1.9%) patients required a reoperation because of splenic infarction at 3 to 100 days postoperatively because of abdominal pain and/or fever. Median follow-up was 2.7 years (mean 4.5 years, range 0-21 years). There was evidence of perigastric varices in 16 of 65 (25%) patients who had follow-up imaging at a median of 3.4 years, but none of the 158 patients developed gastrointestinal bleeding or hypersplenism.Conclusions: Spleen preservation with the Warshaw operation has a low postoperative failure rate of 1.9%. Radiologic evidence of asymptomatic perigastric varices was identified in 25% of patients. There were no clinical consequences of perigastric varices in any patient during a follow-up period of up to 21 years.