腹腔镜胰十二指肠切除术中钩突处理技巧  

Management of pancreatic uncinate process in laparoscopic pancreaticoduodenectomy

作　　者：谭志健[1] 沈展涛[1] 陈桂豪 黄有星[1] 陈彦辰[1] 吴祥 刘一峰 朱春宝 钟小生[1] TAN Zhi-jian;SHEN Zhan-tao;CHEN Gui-hao;ZHONG Xiao-sheng(Department of Pancreatobiliary Surgery,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广东省中医院胰腺中心,广东广州510120 [2]广州中医药大学第二临床医学院,广东广州510405

出　　处：《中国实用外科杂志》2022年第5期535-538,共4页Chinese Journal of Practical Surgery

基　　金：广东省中医院院内专项面上项目(No.YN2018ML01)。

摘　　要：腹腔镜胰十二指肠切除术(LPD)是腹部高难度手术之一,对手术技巧、团队配合等要求较高。其中,因胰腺钩突部位解剖深在、暴露困难,钩突的处理为LPD的难点;钩突及胰腺系膜的完整切除,成为LPD的关键。笔者团队通过探索、改进、优化LPD手术路径和技术细节,在开展多角度动脉入路的基础上,应用中间、左后组合入路,原位精准处理关键血管—胰十二指肠下动脉(IPDA),实现钩突和胰腺系膜安全、完整切除。该技巧能适应不同难度的钩突切除,并且符合肿瘤手术学“No touch”理念。The laparoscopic pancreatoduodenectomy(LPD)is a demanding abdominal operation that necessitates advanced surgical skills and teamwork.Because of the deep anatomical location and difficult exposure of the pancreatic uncinate process,the treatment of the uncinate process has been the difficult in LPD;complete resection of the uncinate process and mesopancreas has become the cornerstone of LPD.The LPD surgical path and technical aspects were investigated,modified,and optimized by author’s team.The middle and left posterior combined approach was used to correctly deal with the important vascular-inferior pancreaticoduodenal artery(IPDA)in situ,to ensure safe and complete excision of the uncinate process and mesopancreas,based on the multi-angle arterial approach.This technique is adaptable to a wide range of difficult uncinate process resections and adheres to the Notouch oncologic principles.

关 键 词：腹腔镜胰十二指肠切除术 动脉入路 钩突 胰腺全系膜切除 

分 类 号：R6[医药卫生—外科学]