左后下动脉优先入路在腹腔镜胰十二指肠切除术中的临床应用  

Clinical application of left posterior inferior artery priority approach in laparoscopic pancreaticoduodenectomy

作　　者：柴伟[1] 张执全[1] 雷豹[1] 孟宇[1] 袁俊建[1] 赵秀雷[1] 张雷[1] 刘汝海[1] Chai Wei;Zhang Zhiquan;Lei Bao;Meng Yu;Yuan Junjian;Zhao Xiulei;Zhang Lei;Liu Ruhai(Department of General Surgery,Hebei Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]河北沧州市中心医院普通外科,沧州061000

出　　处：《中华胰腺病杂志》2020年第6期429-433,共5页Chinese Journal of Pancreatology

摘　　要：目的探讨左后下动脉优先入路在腹腔镜胰十二指肠切除术(LPD)中应用的安全性及可行性。方法收集2018年9月至2020年3月间沧州市中心医院普外科收治的33例行左后下动脉优先入路的LPD患者临床资料。所有患者在完成术中探查后优先由肠系膜下静脉与Treitz韧带之间进入胰头十二指肠后间隙,显露下腔静脉、左肾静脉及肠系膜上动脉起始部,完成16组淋巴结探查,同时在肠系膜上动脉左侧离断胰腺钩突系膜,切断胰十二指肠下动脉。明确肿瘤可切除后常规切除标本,按照Child顺序进行全腔镜下消化道重建。结果33例患者均成功实施左后下动脉优先入路LPD,手术时间为(379.2±64.8)min,左后下入路肠系膜上动脉探查及钩突离断时间为(40.7±16.3)min,术中出血量为(276.4±103.5)ml,淋巴结清扫数目为(14.4±5.6)枚,R0切除率为100%;术后并发症发生率为39.4%(13/33),其中胰瘘发生率为27.3%(9/33),B或C级胰瘘发生率为12.1%(4/33);术后平均住院时间为(16.4±6.7)d。结论左后下动脉优先入路解剖层面清晰、操作简单,可优先完成对肠系膜上动脉及胰腺钩突的解剖及探查,并可实现肠系膜上动脉右侧至少180°的钩突系膜切除,提高手术R0切除率,具有一定的临床应用价值。Objective To explore the safety and feasibility of the priority approach of left posterior inferior artery in laparoscopic pancreatoduodenectomy(LPD).Methods The clinical data of 33 patients with LPD using priority approach of left posterior inferior artery admitted to the Department of General Surgery of Cangzhou Central Hospital from September 2018 to March 2020 were collected.During the operation,the space behind pancreatic head and duodenum was entered from the space between inferior mesenteric vein and Treitz ligament after the exploration in all the patients;the inferior mesenteric vein,the left renal vein and the beginning of the superior mesenteric artery were exposed and 16 groups of lymph nodes were checked;and the mesentery of uncinate process of pancreas was cut off at the left side of the superior mesenteric artery at the same time;and inferior pancreaticoduodenal artery was cut.After confirming that the tumor can be resected,the tumor was conventionally resected and the digestive tract was reconstructed under the laparoscopy according to the order of child.Results Laparoscopic pancreatoduodenectomy using priority approach of left posterior inferior artery was successfully performed in 33 patients.The operation time was(379.2±64.8)min,the exploration time of the superior mesenteric artery and the disconnection time of uncinate process were(40.7±16.3)min,the intraoperative bleeding volume was(276.4±103.5)ml,the number of lymph node dissections was(14.4±5.6),the R0 resection rate was 100%,and the postoperative complications rate was 39.4%(13/33).Among them,the incidence of pancreatic fistula was 27.3%(9/33),and that of grade B or C pancreatic fistula was 12.1%(4/33).The average hospital stay was(16.4±6.7)days.Conclusions The superior approach of the left posterior inferior artery had a clear anatomical level and simple operation.It can dissect and explore the superior mesenteric artery and the uncinate process of the pancreas in priority,and can also achieve the resection of the mesentery of uncin

关 键 词：胰十二指肠切除术 腹腔镜检查 肠系膜上动脉 动脉入路 

分 类 号：R657.5[医药卫生—外科学]