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目的探讨动脉优先入路处理胰腺钩突在腹腔镜胰十二指肠切除术(LPD)中的应用价值。方法回顾性分析2015年2月至2016年1月在复旦大学附属华东医院采用动脉优先入路处理胰腺钩突的LPD治疗的10例患者临床资料。其中男6例,女4例;平均年龄(58±10)岁。患者术前CT及MRI检查诊断胰头或壶腹占位性病变;肿瘤直径<4 cm,无明显血管受侵犯表现,无远处转移。患者均签署知情同意书,符合医学伦理学规定。术中离断钩突时优先处理肠系膜上动脉(SMA),沿SMA根部右侧缘用超声刀骨骼化约3 cm,在SMA后方分离钩突系膜,然后将肠系膜上静脉推向左侧,自下向上完整游离钩突。观察患者围手术期情况及并发症。结果 10例患者均成功实施LPD,无中转开腹。手术时间(401±72)min,术中钩突系膜离断处理时间(34±9)min,术中出血量(255±183)ml。术后病理示所有标本切缘均阴性,清扫淋巴结(14±8)枚。术后4例出现并发症,其中B级胰瘘2例,胃瘫1例,均经保守治疗治愈;腹腔出血1例,经开腹手术止血治愈。本组患者无围手术期死亡。结论在LPD中,采取动脉优先入路处理胰腺钩突安全、可行,该方法可使钩突完整切除,保证了肿瘤的根治性切除。
Objective To investigate the value of artery preferential approach for the treatment of pancreatic uncinatectomy in laparoscopic pancreatoduodenectomy (LPD). Methods The clinical data of 10 patients who underwent LPD for the treatment of pancreatic uncinatectoma by artery prioritization at East China Hospital of Fudan University from February 2015 to January 2016 were retrospectively analyzed. Including 6 males and 4 females; mean age (58 ± 10) years. Patients with preoperative CT and MRI diagnosis of pancreatic head or ampullary space-occupying lesions; tumor diameter <4 cm, no obvious vascular invasion, without distant metastasis. All patients signed informed consent, in line with medical ethics rules. During surgery, the superior mesenteric artery (SMA) was preferentially treated with the hook and the superior mesenteric artery (SMA) was sutured along the right edge of the SMA root with an ultrasonic knife approximately 3 cm. The superior mesenteric membrane was separated behind the SMA and the superior mesenteric vein was pushed to the left. From the bottom up completely free hook. Perioperative observation of patients with complications and complications. Results All 10 patients were successfully treated with LPD without conversion to open laparotomy. The operative time (401 ± 72) min, intraoperative unclamping mesangial detachment time (34 ± 9) min, intraoperative blood loss (255 ± 183) ml. Postoperative pathology showed all specimens were negative margin, lymph node dissection (14 ± 8) pieces. Complications occurred in 4 cases after surgery. Among them, 2 cases of grade B pancreatic fistula and 1 case of gastric paralysis were cured by conservative treatment. One case of intraperitoneal hemorrhage was cured by hemostasis. This group of patients without perioperative deaths. Conclusion In LPD, it is safe and feasible to take the artery preferential approach to treat the uncinate process of the pancreas. This method can completely remove the uncinate process and ensure the radical resection of the tumor.