胰腺上缘入路定点解剖肝总动脉临床应用研究  

Suprapancreatic-approach fixed dissection of common hepatic artery for surgery

作　　者：汤睿[1] 李昂[1] 张新静 于里涵 杨世伟[1] 韩东冬[1] 董家鸿[1] 卢倩 TANG Rui;LI Ang;ZHANG Xin-jing(Hepatopancreatobiliary Center,Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院肝胆胰外科肝脏移植中心,北京102218

出　　处：《中国实用外科杂志》2018年第12期1414-1417,共4页Chinese Journal of Practical Surgery

基　　金：北京市医管局扬帆计划(No.ZYLX201712)

摘　　要：目的探讨在肝总动脉无变异情况下,经胰腺上缘入路定点解剖肝总动脉的方法及临床效果。方法清华大学附属北京清华长庚医院采用前瞻性研究,自2018年1月至6月,连续选取肝总动脉无变异的20例全肝移植物和20例肝胆胰恶性肿瘤病人作为研究对象。移植物自胰腺上缘入路开始肝动脉修剪。肝胆胰恶性肿瘤病人为开放手术,均须接受区域淋巴结清扫,于No.8a淋巴结和胰腺上缘之间首先分离出肝总动脉后分别向近心端及远心端骨骼化肝总动脉及肝固有动脉。结果全肝移植物解剖胰腺上缘软组织后可迅速显露肝总动脉,继续向两侧解剖顺利完成动脉修剪。移植手术成功完成,术后4周随访证实肝动脉功能正常。恶性肿瘤病人可优先解剖出肝总动脉,并向远心端和近心端清扫No.8a、12及No.9淋巴结右侧部分,骨骼化肝总和固有动脉,成功完成区域淋巴结廓清,术后4周随访无肝动脉相关并发症发生。结论胰腺上缘入路肝总动脉定点解剖可作为须行肝总和肝固有动脉骨骼化手术的常规方式。亦可经此入路起始修剪全肝移植物动脉。Objective To describe the detailed procedure and application effect of suprapancreatic-approach fixed dissection of common hepatic artery (CHA)for surgery without common hepatic artery variation.Methods From January to June 2018,20 whole liver grafts of deceased-donor liver transplantation and 20 patients of hepatopancreatobiliary malignancy admitted in Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital were consecutively enrolled in the prospective study.The artery preparation on grafts started from CHA of suprapancreatic-approach.Patients all received laparotomy and radical tumor resection.Hepatic artery skeletonizafion started by dividing CHA that located between No.8a lymph node and suprapancrease.Results Graft CHA were exposed rapidly by dissecting soft tissue at the upper edge of the pancreas.Graft hepatic artery preparation finished smoothly along CHA trunk.All 20 grafts were successfully planted into recipients.Ultrasound follow-up for 4 weeks post-operation showed normal hepatic artery.All 20 patients with malignant tumor successfully received radical resection and lymph node dissection of No.8a,12 and fight portion of No.9,with hepatic artery skeletonization.No complication about hepatic artery happened during perioperative period for 4weeks follow-up.Conclusion Suprapancreatic-path fixed dissection of CHA during surgery can be the routine style for hepatic artery skeletonization.The manner may also be suitable to whole liver graft hepatic artery preparation.

关 键 词：胰腺上缘入路 淋巴结清扫 肝总动脉 全肝移植物修剪 

分 类 号：R6[医药卫生—外科学]