完全腹腔镜根治性胰十二指肠切除术(联合肠系膜上静脉切除人工血管重建)  

Total laparoscopic radical pancreaticoduodenectomy after neoadjuvant chemotherapy(combined with superior mesenteric vein resection and artificial vascular reconstruction)

作　　者：韩显林[1] Han Xianlin(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院基本外科,北京100730

出　　处：《中华普外科手术学杂志（电子版）》2023年第2期133-133,共1页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：北京协和医院杰出青年基金项目(JQ201701)。

摘　　要：常规五孔法布局Trocar孔,先作Kocher切口,游离胰颈部下缘,明确肿瘤侵犯肠系膜上静脉(SMV)情况,评估为可切除后离断远端胃,解剖并悬吊肝总动脉,清扫第8、12组淋巴结,离断胃十二指肠动脉(GDA),切除胆囊,离断胆总管。转向结肠下,离断近端空肠,分离Treitz韧带。游离脾静脉后,于胰腺颈部离断胰腺。将受侵犯SMV节段的近远端分别游离后悬吊,紧邻肠系膜上动脉(SMA)右侧壁离断钩突(动脉优先入路),将SMV近远端阻断后切除标本及受侵犯的SMV(长度约3 cm)。使用直径8 mm人工血管将SMV近远端分别吻合重建。取出标本后按照胰肠、胆肠、胃肠的顺序完成吻合。The Trocars were laid out in a conventional five-port approach.A Kocher maneuver was performed at the beginning,the inferior margin of the pancreatic neck was then dissected and the tumor invasion to the superior mesenteric vein(SMV)was evaluated.The distal stomach was resected after assessment as resectable,and the common hepatic artery was dissected and suspended as No.8 and 12 lymphadenectomy performed,and then the gastroduodenal artery(GDA)was isolated and ligated,the gallbladder was removed with the common bile duct divided.The proximal jejunum was divided distal to the ligament of Treitz and dissected.The pancreas was subsequently divided at the neck and the splenic vein was exposed and ligated.The proximal and distal ends of the invaded SMV segments were dissected and suspended.The uncinate process was freed from the right wall of superior mesenteric artery(SMA)(in arterial-first approach).Finally,the specimen with the invaded SMV(approximately 3 cm in length)were removed during the blockage of both proximal and distal ends of the SMV.The proximal and distal ends of the SMV were then anastomosed and reconstructed using an artificial vessel with a diameter of 8 mm.The specimen was sent for pathological diagnosis.The pancreaticojejunostomy,choledochojejunostomy and gastrojejunostomy was preformed intracorporeally.

关 键 词：胰腺肿瘤 腹腔镜 胰十二指肠切除术 动脉优先 人工血管重建 

分 类 号：R657.5[医药卫生—外科学]