腹膜后淋巴脂肪板层根治性切除术——胰头癌根治术的新策略  

Radical resection of retroperitoneal lipo-lymphatic layer for pancreatic head cancer： a new strategy of pancreaticoduodenectomy

作　　者：彭淑牖[1] 李江涛[1] 秦仁义[2] 刘颖斌[3] 洪德飞[4] 王建伟[5] 王敏[2] 吴文广[3] 黄从云[6] 谭志健[7] 

机构地区：[1]浙江大学医学院附属第二医院普通外科,310009 [2]华中科技大学同济医学院附属同济医院胆胰外科 [3]上海交通大学医学院附属新华医院普外科 [4]浙江省人民医院肝胆外科 [5]浙江大学医学院附属第二医院肿瘤外科 [6]汕头大学医学院附属粤北人民医院普通外科 [7]广州中医药大学附属广东省中医院外科

出　　处：《中华肝胆外科杂志》2015年第7期437-441,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的总结评价胰头癌行根治性胰十二指肠切除新策略——腹膜后淋巴脂肪板层根治性切除术（RRRLLL）。方法回顾性分析作者单位2012年1月至2015年2月，133例胰头癌患者采用RRRLLL的手术方式和临床资料。结果133例患者中，门静脉一肠系膜上静脉血管侧壁切除修补和静脉切除端端吻合重建39例。平均手术时间288min，平均出血量454ml，平均术后排气时间6．2d，平均术后住院日13．2d。31例（23．3％）发生术后并发症，其中肺部感染7例，胰漏（A级）6例，切口感染5例，胃排空障碍5例，胆漏4例，术后出血4例，术后腹泻2例，无围手术期死亡病例。结论RRRLLL明确了胰头癌根治性胰十二指肠切除术的三维清扫空间范围，易于安全操作，是胰头癌切除理念的更新，对提高胰头癌手术的安全性和疗效具有重要意义。Objective To evaluate a new strategy of Radical Resection of Retroperitoneal Lipo- Lymphatic Layer （RRRLLL） for pancreatic cancer in pancreaticoduodenectomy（PD）. Methods From Ja- nuary 2012 to February 2015, 133 patients with pancreatic head adenocarcinoma underwent RRRLLL in PD, the data of surgical technique and clinical peri-operative results were analyzed. Results All the 133 pa- tients underwent RRRLLL in pancreatieoduodenectomy. The mean operation time was 288 minutes, and the mean blood loss was 454 ml. 39 patients underwent resection and repair of vessel lateral wall or end-to-end anastomosis of portal vein or super mesenteric vein. 31 cases with postoperative complications （23.3 % ） and no mortality. The incidence rates of postoperative bleeding, pancreatic leakage , biliary leakage, delayed gastric emptying and diarrhea ,were 3.0% , 4.5 % , 3.0% , 3.8% , and 1.5% respectively. Conclusions As a new concept, RRRLLL depicts a definite area of dissection for PD. As a surgical procedure, it is rela- tively easy to perform. Difficult cases also can be tackled safely. This updated concept of PD is promising in terms of its effectiveness and safety. Further study is needed to confirm its radicalness.

关 键 词：胰头癌 胰十二指肠切除术 胰腺全系膜切除 腹膜后淋巴脂肪板层根治性切 除术 

分 类 号：R735.9[医药卫生—肿瘤]