摘要
目的介绍“钩突优先切除”在根治性钩突完整切除术中的应用。方法2010年12月至2011年6月共有23例患者采用了“钩突优先”的方法，其中进行了20例胰头十二指肠切除术及保留幽门的胰头十二指肠切除术，3例全胰十二指肠切除术（其中2例保留了脾动静脉和脾脏）。对23例患者临床资料、病理检查结果和术中术后的情况进行回顾性分析，介绍临床应用钩突优先切除的初步体会。结果此方法成功应用于23例患者，其中胰头癌中合并门静脉的整块切除1例，门静脉的阻断时间为16min。术中发现3例患者存在异位或副肝右动脉，发生率为21％，1例患者肝总动脉起源于肠系膜上动脉，均得到确认和保存。3例行全胰十二指肠切除术，胰腺完整切除，其中2例保存了脾动静脉和脾脏。无术中大出血或误伤等其他并发症发生，平均失血约600ml。术后无顽固性腹泻的发生。包括胰腺腹膜后切缘在内的所有外科切缘均阴性。结论“钩突优先切除”是一项有效、安全的胰腺外科创新技术，可作为现代胰腺外科技术的补充。该项技术的优势在全胰切除术中尤为明显。与标准胰腺切除比较，其对预后的影响仍有待多中心的临床研究。
Objective To describe a novel technical modification of the uncinate process first ap- proach with a retrograde dissection of the pancreatic head. Methods The authors described the surgi- cal technique, and reported their preliminary experience. The surgical data, postoperative outcomes and pathological results of patients who were submitted to PD/PP-PD （20 patients） and TP （3 patients） for pancreatic neoplasm using ＂the uneinate process first＂ technique between December 2010 and May 2011 were reviewed. Retrograde resection of the pancreatic head was performed starting with the uneinate process after division of the first jejunal loop. The transection of the pancreas was the last operative step of the resection. The technical aspects and possible advantages of this procedure were discussed. Results The authors used this technique successfully in 23 patients. In 3 patients with a replaced or accessory RHA, the arteries were all successfully preserved. In another patient with a re placed HCA, the artery was also successfully preserved. In 1 patient with adenoearcinoma which in- volved the SMV, en-bloc vascular resection was carried out. Additionally, the authors used this tech- nique on 3 patients with IPMN-2 and SPPN-1 to carry out total pancreatectomy. The uncinate process first was performed on 23 patients without any intraoperative and postoperative complication and mas- sive bleeding. No patient required blood transfusion. The surgical margins, including retroperitoneal margins were negative. Conclusions The ＂uncinate process first＂ approach can be used as an alternative approach in modern pancreatic surgery. Further studies are required to evaluate this procedure regarding operative parameters and postoperative outcomes when compared with the standard resectional procedure.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2012年第9期684-687,共4页
Chinese Journal of Hepatobiliary Surgery
