肠系膜上动脉路径在胰十二指肠切除及合并血管切除术中的应用  

Superior mesenteric artery approach for pancreaticoduodenectomy or its combination with vessel resection

作　　者：龙光辉[1] 谢勇[1] 张光涛[1] 钟立明[1] 张风涛[1] 

机构地区：[1]北京大学深圳医院肝胆外科,广东深圳518036

出　　处：《中国普通外科杂志》2014年第3期291-296,共6页China Journal of General Surgery

摘　　要：目的:探讨经肠系膜上动脉途径行胰头十二指肠切除及合并血管切除的可行性及优劣。方法:2012年9月—2014年2月采用肠系膜上动脉旁路径的方法实施胰头十二指肠切除术治疗胰头癌及壶腹周围癌16例,其中实施门静脉、肠系膜上静脉切除重建手术5例。患者均首先显露、游离肠系膜上动、静脉并清除其周围的神经淋巴组织,再打通胰后隧道并切断胰腺颈部,最后切除胰腺钩突或被侵犯的门静脉、肠系膜上静脉。结果:15例术后顺利恢复后出院,1例术后出现肾功能衰竭、肺部感染,放弃治疗自动出院。术中平均出血量为470 mL,平均手术时间4.5 h,无手术中及术后死亡。5例术后出现胰瘘等并发症,均经保守治疗后痊愈。切缘病理检查均阴性,淋巴结及后腹膜神经、淋巴组织阳性检出率较高。结论:经肠系膜上动脉途径行胰头十二指肠切除术治疗胰头癌及壶腹周围癌安全可行,并可增加R0切除率。Objective： To investigate the feasibility and effectiveness resection via superior mesenteric artery （SMA） approach. ofpancreaticoduodenectomy （PD） or PD with vessel Methods： From September 2012 to February 2014, pancreaticoduodenectomy via SMA approach was performed in 16 cases for pancreatic head or periampuUary carcinoma, and S of them underwent portal vein （PV）/superior mesenteric vein （SMV） resection and reconstruction. In all patients, the SMA and SMV were exposed and isolated, and neural and lymphatic tissues were resected, then, a retropancreatic tunnel was created and the neck of the pancreas was divided, and finaUy, the resection ofuncinate process of pancreas or combined excision of the involved PV and SMV was performed. Results： Fifteen patients recovered after surgery and were discharged from hospital, and one patient whodeveloped renal failure and lung infection after surgery refused treatment and left the hospital against medical advice. The average intraoperative blood loss was 470 mL and operative time was 4.5 h, and no operative or postoperative death occurred. Five cases developed postoperative complications such as pancreatic fistula, which were all resolved by conservative treatment. The pathological sections of the excised specimen margins were all negative, and the positive detection rate in lymph nodes, and retroperitoneal neural and lymphatic tissues was high. Conclusion： PD via superior mesenteric artery approach for pancreatic head or periampullary carcinoma is safe and feasible, and it can also improve the R0 resection rate.

关 键 词：胰十二指肠切除术 肠系膜上动脉 门脉系统 

分 类 号：R657.5[医药卫生—外科学]