扩大胰十二指肠切除术  

Extended Pancreaticoduodenectomy

作　　者：王槐志[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所,重庆市400038

出　　处：《中华普外科手术学杂志（电子版）》2017年第4期283-283,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：1.沿着自然的解剖间隙进行分离。2.所有大血管直接套线结扎,避免钳夹,以免形成假性动脉瘤,导致术后迟发性的大出血。3.横断胆总管后立即引流胆管,可避免胆汁进入手术野,让手术野清爽干净。4.切断胰颈前在胰腺上下缘各缝1针,将胰头端结扎,可减少切断胰颈时的出血。5.清扫范围:上至肝门,下至肠系膜下动脉起始部,右至右肾门,左至腹主动脉左侧缘。肠系膜上动脉要360°骨骼化。6.胰管空肠粘膜对粘膜吻合是最接近生理状态的吻合方式,容易操作,胰漏发生率也不高。1. The dissection is carried out along the natural anatomical space. 2. All large vessels are ligated directly to avoid clamping,so as to avoid the formation of pseudoaneurysms,resulting in delayed postoperative massive bleeding. 3. After the transection of the common bile duct,drainage of common bile duct is carried out immediately. This performance can avoid that bile flow into the surgical field,so that the surgical field looks clean and refreshing. 4. The suture of upper and lower edge of the pancreas,ligation of the head end of the pancreas before cutting the neck of the pancreas,can reduce the bleeding when cutting off the neck of the pancreas. 5. Range of lyphatic and nerve resection： up to the liver hilum,down to the beginning of the inferior mesenteric artery,right to right renal hilum,left to the left side of the abdominal aorta. All the connective tissues in the region together with lymph nodes and nerves are completely resected.The superior mesenteric artery needs to be skeletonized by 360 degrees. The dissection should be carried out along the natural anatomical space,which can reduce lymphatic and chylous leakage. 6. The duct to mucosa anastomosis of pancreatic duct and jejunum is one kind of anastomosis which is very close to the physiological state. It is easy to perform and the rate of pancreatic leakage is not high.

关 键 词：胰十二指肠切除术 骨骼化 淋巴清扫 

分 类 号：R657.5[医药卫生—外科学]