"后入路、钩突先行、动脉优先"在腹腔镜胰十二指肠切除术中的价值分析  

The value of"posterior approach,uncinate process priority,artery first"in laparoscopic pancreatoduodenectomy

作　　者：王树鹏 刘松阳[1] 张威[1] 王英超[1] 纪柏[1] 孟令宇[1] 刘亚辉[1] Wang Shupeng;Liu Songyang;Zhang Wei;Wang Yingchao;Ji Bai;Meng Lingyu;Liu Yahui(Secondary Department of Hepatobiliary and Pancreatic Surgery,the 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,长春市130021

出　　处：《中华医学杂志》2020年第42期3328-3331,共4页National Medical Journal of China

摘　　要：目的探讨"后入路、钩突先行、动脉优先"手术路径在腹腔镜胰十二指肠切除术中的价值分析。方法回顾性分析2018年1月至2019年4月在吉林大学第一医院肝胆胰外二科接受"后入路、钩突先行、动脉优先"手术方式,完成腹腔镜胰十二指肠切除200例患者临床资料。从手术时间、术中出血量、淋巴结的清扫、住院时间等,分析探讨"后入路、钩突先行、动脉优先"手术方式的优势。结果使用"后入路、钩突先行、动脉优先"200例患者,肠系膜上动脉(SMA)的显露良好,总手术时间(260.2±50.1)min,标本切割时间(86.6±18.7)min,术中出血量50(50~100)ml,平均淋巴结清扫数目(19.2±7.4)个,术后住院时间(17.9±9.9)d。结论"后入路、钩突先行、动脉优先"入路方式不但可以保护变异肝动脉血管,而且可以早期探查SMA,明确肿瘤与SMA的位置关系,实现R0切除,并且减少术中出血量、缩短手术时间,在临床中是安全可行的。Objective To explore the value of"posterior approach,uncinate process priority,artery first"in laparoscopic pancreatoduodenectomy.Methods The clinical data of 200 patients who underwent laparoscopic pancreatoduodenectomy from January 2018 to April 2019 in the Second Department of Hepatobiliary and Pancreatic Surgery,the First Hospital of Jilin University were analyzed retrospectively.Meanwhile,the advantages of"posterior approach,uncinate process priority,artery first"were analyzed.Results Two hundred patients were treated with"posterior approach,uncinate process priority,artery first".The average total operation time was(260.2±50.1)min,sample cutting time was(86.6±18.7)min,intraoperative bleeding volume was 50(50-100)ml,average number of lymph node dissection was(19.2±7.4),and average hospitalization time was(17.9±9.9)days.Conclusion The"posterior approach,uncinate process first,artery first"approach not only protects the variant hepatic artery,but also allows early detection of SMA,clarifies the positional relationship between the tumor and SMA,realizes R0 resection,and reduces the amount of bleeding during operation and shortens the operation time,which is safe and feasible in clinical setting.

关 键 词：腹腔镜 胰十二指肠切除术 手术入路 后入路、钩突先行、动脉优先 

分 类 号：R657.5[医药卫生—外科学]