摘要
目的腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)是难度最大的腹腔镜手术之一,涉及的器官众多,解剖关系复杂,在手术入路方面有许多值得探讨的地方,为探讨LPD安全快捷的手术入路,进行了本研究。方法自2002年11月至2007年7月,在我中心成功进行了15例LPD,其中男11例,女4例,年龄35～76岁,平均54.9岁,十二指肠乳头腺癌7例,壶腹部腺癌3例,壶腹部乳头状腺癌1例,胰头腺癌1例,胰头内分泌小细胞癌1例,胰头神经内分泌癌1例,十二指肠乳头腺癌并胆总管下段腺癌1例。本文回顾总结我院15例腹腔镜胰十二指肠切除术的手术过程,分析十二指肠侧壁入路在腹腔镜胰十二指肠切除术中的应用。结果手术过程中采用紧贴着十二指肠侧壁的入路,均能快速安全地进行分离解剖各结构。采用十二指肠侧壁的入路的各步骤操作包括一下几点:①紧贴十二指肠侧壁切开后腹膜至十二指肠、胰头后壁,探查肿物是否己侵及下腔静脉;②沿十二指肠侧壁解剖,寻找肠系膜血管根部,探查病变与肠系膜静脉、门静脉关系;③经十二指肠侧壁往上解剖显露胆总管,清扫胆管、十二指肠旁的淋巴结;④提起十二指肠球部,横断胃窦部,显露腹腔动脉根部、肝总动脉、肝固有动脉及胃十二指肠动脉;⑤沿十二指肠下侧壁解剖,切断肠壁外结缔组织,经肠系膜上血管根部后方将十二指肠升段全程以及近端空肠游离;⑥向右上腹提拉十二指肠,显露胰腺钩突与门脉外侧血管,切除胰腺钩突。结论十二指肠侧壁入路是腹腔镜胰十二指肠切除术中的安全快捷的手术入路。
Objective Laparoscopic pancreaticoduodenectomy（LPD） is one of most difficult laparoscopic operations.It involvs many important organs whose anatomy is complex.The issue of operative approach is worth of investigation.The aim of this article is to expore safe and rapid operative approaches in LPD.Materials and Method During November of 2002 and July of 2007,15 cases of LPD were performed successfully in our centre.11 patients were male,and 4 femal.The age ranged from 35 to 76 years,average 54.9 years.The indications included 7 cases of adenocarcinoma of duodenal papilla,3 cases of adenocarcinoma of ampulla,1 case of papillary adenocarcinoma,1 case of adenocarcinoma of head of pancreas,1 case of endocrine small cell carcinoma,1case of neuroendocrine carcinoma,1 case of adenocarcinma of duodeal papilla and lower common bile duct.We reviewed the operative procedures of 15 cases of LPD to analyze the application of duodenal-wall approach in LPD.Results Most organs and tissues were dissected safely and rapidly along the duodenal wall.The duodenal-wall approach involves the following procedures：①the exploration of inferion vena cava.The retroperitoneum was open along the wall of decending part of duodenum.The duodenum and head of pancreas were dissected to their back side with this approach,and they could be pulled aside to show the inferion vena cava.②the exporation of portal vein.Dissection was continued along the duodenal wall to find the upper part of superior mesenteric vein,and the portal vein could be reached by following the superior mesenteri vein.③the common bile duct was dissected along the upper wall of duodenum.,and the lymph nodes along duodenum and bile duct were cleared.④The stomach was transected after the first part of duodenal was dissected and lifted.Then the celiac artery,common hepatic artery,proper hepatic artery and the gastroduodenal artery could be exposed.⑤the whole assending part of duodenum and proximal jejunum were dissected along the lower side of duodenal wall,and they were pulled to the right epicolic area throug the space behind the superior mesenteric vessels.⑥The vessels between the unciform process of pancreas and portal vein were exposed by pulling the distant duodenum and proximal jejunum to the right epicoli area.Then the unciform process of pancreas could be cut using ultrasonic dissector.Conclusion The duodenal-wall approach is a safe and efficient operative approach in LPD.
出处
《中华腔镜外科杂志（电子版）》
2008年第1期19-23,共5页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
关键词
腹腔镜
胰十二指肠切除术
手术技巧
手术入路
微创
Laparoscopic
Pancreaticoduodenectomy
Operative approach
Surgery
Minimally invasive surgery
Operative techniques
