腹腔镜胰十二指肠切除术血管处理策略  

Management strategy of blood vesselsduring laparoscopic pancreaticoduodenectomy

作　　者：段小辉[1,2] 毛先海 Duan Xiaohui;Mao Xianhai(Department of Hepatobiliary Surgery/Research Laboratory of Hepatobiliary Tumor,Hunan Provincial People′s Hospital,First Affiliated Hospital,Hunan Normal University,Hunan Changsha 410005,China;Clinical Medical Research Center for Biliary Disease of Hunan Province,Hunan Changsha 410005,China)

机构地区：[1]湖南省人民医院肝胆外科/肝胆肿瘤研究室湖南师范大学附属第一医院,湖南长沙410005 [2]湖南省胆道疾病防治临床医学研究中心,湖南长沙410005

出　　处：《腹部外科》2021年第4期261-263,共3页Journal of Abdominal Surgery

基　　金：湖南省自然科学基金(2018JJ3294,2019JJ80007);湖南省高层次卫生人才“225”基金。

摘　　要：该文围绕腹腔镜胰十二指肠切除术中血管处理策略展开阐述。开展腹腔镜胰十二指肠切除术后应熟悉胰头十二指肠切除手术重点区域血管解剖并且通过术前三维重建了解血管变异。提出应用"一轴二面四区"及"危险三角"的解剖概念处理胰十二指肠血管。术中注意避免动脉内膜损伤和静脉撕脱,尤其注意腹腔镜下血管的"帐篷效应",避免血管损伤。手术团队应增强手术配合意识,及时处理术中意外出血,避免灾难性大出血的发生。严密监测术后出血和早期积极处理,可减少术后严重并发症的发生。To summarize the strategy of blood vessels during laparoscopic pancreaticoduod-enectomy.During laparoscopic pancreaticoduodenectomy,surgeons should be familiar with vascular anatomy of pancreaticoduodenal region.Preoperative three-dimensional reconstruction is utilized for grasping vascular variations.The concepts of"1 axis,2 sides&4 areas"and"dangerous triangle"have been proposed for vascular handling.Great efforts should be taken to avoid arterial intima injury and venous avulsion,especially"tent effect"of blood vessels.Team cooperation should be further strengthened and intraoperative accidental bleeding promptly arrested to avoid massive bleeding.Close monitoring of postoperative bleeding and early active intervention may reduce the occurrence of serious complications.

关 键 词：胰十二指肠切除术 腹腔镜 血管处理 策略 

分 类 号：R619.1[医药卫生—外科学]