前入路静脉优先控制技术在腹腔镜胰十二指肠切除术中的应用价值  

Clinical value of anterior"vein-first"approach during laparoscopic pancreaticoduodenectomy

作　　者：张东生[1] 冷开明 李鸾 赵成健[1] 潘颖 高维克 李文迪 类成刚[1] 董瑞鹏 康鹏程[3] 崔云甫[3] 史光军[1] Zhang Dongsheng;Leng Kaiming;Li Luan;Zhao Chengjian;Pan Ying;Gao Weike;Li Wendi;Lei Chenggang;Dong Ruipeng;Kang Pengcheng;Cui Yunfu;Shi Guangjun(Department of Hepatobiliary Surgery,Qingdao Municipal Hospital,Shandong Qingdao 266071,China;Department of Traditional Chinese Medicine,Qingdao Municipal Hospital,Shandong Qingdao 266071,China;Department of Hepatopancreatobiliary Surgery,Second Affiliated Hospital of Harbin Medical University,Heilongjiang Harbin 150086,China)

机构地区：[1]青岛市市立医院肝胆外科,山东青岛266071 [2]青岛市市立医院中医科,山东青岛266071 [3]哈尔滨医科大学附属第二医院胆胰外科,黑龙江哈尔滨150086

出　　处：《腹部外科》2021年第6期443-446,共4页Journal of Abdominal Surgery

基　　金：山东省自然科学基金面上项目(ZR202103030420);青岛市优秀医学人才项目、青岛市医药科研指导计划(2020-WJZD025)。

摘　　要：目的探讨前入路静脉优先控制技术在腹腔镜胰十二指肠切除术中应用价值。方法回顾性分析青岛市市立医院自2020年3月至2021年8月期间41例采用前入路静脉优先控制技术行腹腔镜胰十二指肠切除术病人的临床资料。结果41例均顺利完成手术,术中无中转开腹,其中2例(4.9%)术中发现异位右肝动脉起源于肠系膜上动脉。手术时间为(5.1±2.4)h,术中出血(100±155)mL,清扫淋巴结(8.5±3.4)枚,恶性病例中均获得R0切除,术后住院时间(12.6±8.7)d。术后并发症包括:生化漏10例(24.4%)、B级胰瘘7例(17.1%)、C级胰瘘1例(2.4%),腹腔出血3例(7.3%),胆漏4例(9.8%),术后胃排空障碍3例(7.3%),腹腔感染2例(4.9%),术后30 d内死亡1例(2.4%)。结论腹腔镜下胰头十二指肠切除术中前入路静脉优先控制技术是简单易行的,对减少术中出血、缩短手术时间具有重要的意义,适合推广使用。Objective To explore the clinical value of anterior"vein-first"approach during laparoscopicpancreaticoduodenectomy.Methods A retrospective study was reviewed for clinical data of 41 patients undergoing laparoscopic pancreaticoduodenectomy at Qingdao Municipal Hospital.Results All operations were successfully completed without any conversion into laparotomy.Two cases(4.9%)had right ectopic hepatic artery derived from superior mesenteric artery.Average operative duration was(5.1±2.4)h,average intraoperative bleeding(100±155)mL and average number of harvested lymph nodes(8.5±3.4).R0 resection was obtained in all malignant cases and postoperative hospital stay was(12.6±8.7)days.Postoperative complications included biochemical leakage(n=10,24.4%),grade B pancreatic leakage(n=7,17.1%),grade C pancreatic leakage(n=1,2.4%),abdominal hemorrhage(n=3,7.3%),bile leakage(n=4,9.8%),postoperative gastric emptying disorder(n=3,7.3%),abdominal infection(n=2,4.9%)and death within 30 days(n=1,2.4%).Conclusion Anterior"vein-first"approach technique is both simple and efficacious during laparoscopic pancreaticoduodenectomy.It is of great significance to reduce intraoperative hemorrhage and shorten operative duration.A wider popularization is worthwhile.

关 键 词：腹腔镜胰十二指肠切除 前入路 静脉优先 

分 类 号：R730.4[医药卫生—肿瘤] R657.3[医药卫生—临床医学]