经肠系膜上动脉右后入路联合钩突优先腹腔镜胰十二指肠切除术的初步探索和体会  

Preliminary exploration and experience of uncinate-process-first superior mesenteric artery right posterior approach in laparoscopic pancreaticoduodenectomy

作　　者：汪宏翔 徐杰[1] 王佳国 游科[1] 刘作金[1] WANG Hongxiang;XU Jie;WANG Jiaguo;YOU Ke;LIU Zuojin(Department of Hepatobiliary Surgery,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400000,P.R.China)

机构地区：[1]重庆医科大学附属第二医院肝胆外科,重庆400000

出　　处：《中国普外基础与临床杂志》2023年第11期1289-1293,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：重庆医科大学附属第二医院“宽仁英才”项目(项目编号:kryc-lj-2103)。

摘　　要：目的 探讨经肠系膜上动脉(superior mesenteric artery,SMA)右后入路联合钩突优先在腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)中的安全性和可行性。方法 对2022年12月至2023年5月期间重庆医科大学附属第二医院收治的5例行经SMA右后入路联合钩突优先的LPD患者的临床资料进行回顾性分析。结果 5例经SMA右后入路联合钩突优先的LPD手术均顺利完成。手术时间为(366±51)min,术中出血量为(140±42)mL,术后住院时间为(11±2)d。术后病理回示均达到R0切除,5例患者均未出现胃肠瘘、胆汁漏,无明显胃瘫,2例出现生化瘘,术后随访时间为(7±2)月,随访期间均未出现复发。结论 经SMA右后入路联合钩突优先的LPD是一种安全、可行的手术方式,尤其适用于无明显血管浸润且直径≤2 cm的肿瘤。Objective To explore the safety and feasibility of the uncinate-process-first superior mesenteric artery(SMA)right posterior approach in laparoscopic pancreaticoduodenectomy(LPD).Methods The clinical data of 5 patients admitted to the Second Affiliated Hospital of Chongqing Medical University from December 2022 to May 2023 were retrospectively analyzed,all patients underwent uncinate-process-first SMA right posterior approach during LPD.Results All 5 cases of LPD with uncinate-process-first SMA right posterior approach were successfully completed.The operative time was(366±51)min,the intraoperative blood loss was(140±42)mL,and the postoperative hospital stay was(11±2)days.All the postoperative pathological findings reached R0 resection.None of the 5 patients suffered from biliary leakage,bleeding,or gastrointestinal empties,and 2 patients suffered from biochemical fistula,the postoperative follow-up time was(7±2)months,and there was no recurrence during the follow-up period.Conclusion The uncinate-processfirst SMA right posterior approach is a safe and feasible surgical approach,especially for tumors with no obvious vascular invasion and diameter≤2 cm.

关 键 词：腹腔镜胰十二指肠切除术 动脉入路 钩突优先 

分 类 号：R657.5[医药卫生—外科学]