完全腹腔镜“下入路,钩突优先,动脉先行”胰十二指肠切除术的临床应用  

Clinical Application of Total Laparoscopic Pancreatoduodenectomy With Inferior-posterior Uncinate Process and Artery First Approach

作　　者：杨帆[1] 刘亚辉[1] 刘松阳[1] 张威[1] 贾宝兴[1] 王英超[1] Yang Fan;Liu Yahui;Liu Songyang(Department of Hepatobiliary and Pancreatic Surgery,First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院肝胆胰外二科,长春130021

出　　处：《中国微创外科杂志》2018年第10期908-910,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：吉林省自然科学基金(20160101045JC)

摘　　要：目的探讨腹腔镜"下入路,钩突优先,动脉先行"胰十二指肠切除的临床效果。方法 2017年4～12月完成30例"下入路,钩突优先,动脉先行"的腹腔镜胰十二指肠切除,术前诊断为胰头或壶腹部肿瘤。1例有肠系膜上静脉侵犯,腹腔镜下切除肠系膜上静脉2 cm,静脉端端吻合,其余29例无动静脉侵犯或远处转移。在横结肠系膜无血管区打开结肠系膜,做扩大的Kocher切口达Treitz韧带右侧,找到肠系膜上动脉,骨骼化肠系膜上动脉,使其与胰腺钩突离断,悬吊肠系膜上静脉,完全离断胰腺钩突与肠系膜上静脉之间的交通支。结果 30例完全腹腔镜下完成胰十二指肠切除,手术时间(4.3±1.5)h,术中出血(330±75)ml,术后发生A级生化漏8例,B级胰漏2例,淋巴漏5例。术后病理回报,胰腺或壶腹部周围恶性肿瘤26例,良性肿瘤4例。术后住院时间(16.3±7.2)d。结论腹腔镜"下入路,钩突优先,动脉先行"胰十二指肠切除术,手术安全性高,可以完整切除胰腺钩突及肠系膜上动脉周围淋巴结和神经,适合推广。Objective To explore uneinate process and artery first approach panereatoduodeneetomy with inferior-posterior December 2017, 30 cases of laparoseopie pancreatoduodenectomy were performed with the approach of inferior-posterior uneinate process and the artelT first. All the patients were diagnosed as pancreatic head or ampulla malignant tumor preoperatively. One case had superior mesenterie vein invasion, and laparoseopie superior mesenterie vein resection for 2 em and venous end-to-end anastomosis were given. The remaining 29 cases had no artelT or venous infringement or distant transfer. The assistant first raised the transverse colon during the operation, opened the mesentelT in the avaseular zone, made an enlargement of the Koeher, reached the right side of the Treitz ligament, and found the superior mesenterie artelT. The skeletal superior mesenterie artelT was dissociated from the pancreas to free the superior mesenterie vein and suspend the superior mesenterie vein to completely break off the traffic branch between the uneinate process of the pancreas and the superior mesenterie vein. Results Total laparoseopie panereatoduodeneetomy with inferior-posterior uneinate process and artery first approach was completed in the 30 patients under laparoseopy. The operation time was （4.3 ± 1.5） h. The intraoperative bleeding was （330 ± 75） ml. Grade A biochemical leakage occurred in 8 cases and grade B pancreatic leakage in 2 cases. Lymphatic leakage was seen in 5 cases. Postoperative pathological findings included 26 cases of malignant tumors around the pancreas or ampulla and 4 cases of benign tumors. The average length of hospital stay was （ 16.3 ± 7.2） days. Conclusions Laparoseopie panereatoduodeneetomy with inferior-posterior uneinate process and artery first approach is safe and can completely remove the uneinate process of the pancreas and the surrounding mesenterie artelT lymph nodes and nerves. It is a suitable method for the promotion of laparoseopic

关 键 词：胰十二指肠切除术 腹腔镜 手术入路 

分 类 号：R657.5[医药卫生—外科学]