钩突入路腹腔镜胰十二指肠切除术的解剖与临床应用研究

发布时间：2019-07-09 11:18

【摘要】：目的:探讨腹腔镜胰十二指肠切除术相关肠系膜上血管的解剖学特点及其临床意义,以及钩突入路腹腔镜胰十二指肠切除术的安全性与可行性。方法:对4具尸体解剖学观察和96例上腹部MSCTA的血管重建,分析肠系膜上血管的分布与走行;实施钩突入路腹腔镜胰十二指肠切除术,并对所有病例的各项临床观察指标进行分析。结果:1.背侧观的门-肠系膜上静脉可分为三段:胰腺上段、胰腺段和十二指肠段;.其中肠系膜上静脉十二指肠段与肠系膜上动脉的关系密切。2.MSCTA对胰周主要血管的显示率100%,胰周小动静脉的显示率58.3%-85.4%。3.共实施13例钩突入路腹腔镜胰十二指肠切除术,平均手术时间:280±38 min,术中出血:300±45mL,中转开腹率15.4%。清除淋巴结9~15枚,R0切除率100%。术后并发症27.3%,再次手术率15.4%。术后局部复发率7.7%,血行(肝)转移率23.1%。术后1年生存率84.6%,术后2年生存率71.4%,术后3年生存率60%。结论:1.通过尸体解剖与MSCTA研究,发现MSCTA可以提供准确的胰十二指肠切除术相关肠系膜上血管的分布与走行,为钩突入路腹腔镜胰十二指肠切除术提供理论基础。2.从背侧观,可将门静脉-肠系膜上静脉分为胰腺上段、胰腺段和十二指肠段等三段,肠系膜上静脉是腔镜下显露肠系膜上动脉的重要解剖标志,对实施钩突入路腹腔镜胰十二指肠切除术有重要的临床指导意义。3.钩突入路腹腔镜胰十二指肠切除术可以完成胰腺系膜全切除,提高R0切除率,完成标准胰十二指肠切除术的淋巴结清扫。4.钩突入路腹腔镜胰十二指肠切除术具有较好的安全性与可行性,是一种较合理的腹腔镜胰十二指肠切除术的手术方式,值得进一步研究。
文内图片：
图片说明：尸体解剖：胰十二指肠下动、静脉；肠系膜上静脉、胰腺钩突
[Abstract]:Objective: to investigate the anatomical characteristics and clinical significance of superior mesenteric vessels associated with laparoscopic pancreaticoduodenectomy, and the safety and feasibility of laparoscopic pancreaticoduodenectomy via uncinate process approach. Methods: the distribution and course of superior mesenteric vessels were analyzed by anatomical observation in 4 cadavers and vascular reconstruction in 96 cases of upper abdominal MSCTA, laparoscopic Pancreatoduodenectomy by hook approach was performed, and the clinical observation indexes of all cases were analyzed. Result: 1. The dorsolateral portal-superior mesenteric vein can be divided into three segments: the upper segment of the pancreas, the segment of the pancreas and the segment of the duodenum. There was a close relationship between the duodenal segment of the superior mesenteric vein and the superior mesenteric artery. 2.The display rate of MSCTA for the main peripancreatic vessels was 100%, and the display rate of peripancreatic arteriovenous was 58.3% 鈮，

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