动脉优先入路在胰十二指肠切除术中的技术要点  

Application of Artery First Approach for Pancreaticodudenectomy

作　　者：高文涛[1] 蒋奎荣[1] 吴峻立[1] 钱祝银[1] 戴存才[1] 李强[1] 苗毅[1] 

机构地区：[1]南京医科大学第一附属医院胰腺外科中心,江苏南京210029

出　　处：《中国普外基础与临床杂志》2014年第7期802-808,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的 探讨在胰十二指肠切除术中利用动脉优先入路（artery first approach）早期探查肠系膜上动脉（SMA）和腹腔干以判断肿瘤可切除性，并完成以SMA及腹腔干为轴的右侧神经及淋巴组织的完全切除的技术要点。方法 回顾性分析笔者所在医院胰腺外科中心2010年9月至2013年12月期间27例实施动脉优先入路胰十二指肠切除术患者的临床资料。结果 27例患者术前均疑诊为“胰头癌”，且术前CT判断均为交界性可切除者。8例行内引流手术，2例行全胰切除术，17例行胰十二指肠切除术；其中5例行联合门静脉（PV）/肠系膜上静脉（SMV）切除，1例行肝总动脉切除，2例行扩大右侧胰腺切除术。手术时间（281.28±78.53） min （133～354 min），术中出血（352±537） mL （189～1 352 mL）。无术后死亡，无因并发症再次手术者。结论 动脉优先入路适合于术前判断为交界可切除病例，具体的入路方式需根据肿瘤位置以及侵犯情况灵活采用。Objective To evaluate the application of artery first approach in pancreaticodudenectomy， aiming to explore superior mesenteric artery （SMA） and celiac axis in early stage of operation， confirming the resectability and achieving radical resection of the nervous and lymphatic tissues around axis of celiac artery and SMA. Methods The data of 27 patients with suspected carcinoma in pancreatic head who received the artery first approach in pancreaticodudenectomy from Sep， 2009 to Dec， 2013 in our hospital were retrospectively analyized. Results Eight cases received palliative drainage operation， while other 19 cases received radical pancreatectomy， including 2 cases total pancreatectomy and 17 cases pancreaticodudenectomy， with 5 cases portal vein or superior mesenteric vein resection and reconstruction， 1 case common hepatic artery resection， and 2 cases extended right pancreatectomy. The operative time was （281.28±78.53）min （133-354 min）， and amount of bleeding was （352±537） mL （189-1 352 mL）. There were no operative death， and no reoperation due to complications. Conclusion Artery first approach is preferred for patients with borderline resectable tumors， pancreatic surgeon should be familiar to the various approach.

关 键 词：胰十二指肠切除术 动脉优先 肠系膜上动脉 

分 类 号：R735.9[医药卫生—肿瘤]