小肠解旋转技术用于胰十二指肠切除术3例体会

发布时间：2018-04-01 06:02

本文选题：小肠解旋转技术　切入点：胰十二指肠切除术　出处：《中国实用外科杂志》2017年03期

【摘要】：目的探讨小肠解旋转技术及其在胰十二脂肠切除术中的应用。方法回顾性分析复旦大学附属中山医院2016年8月至2016年9月收治的3例接受胰十二指肠切除术病人资料,通过结合术前影像学资料、术后病理学检查结果及术后恢复情况,探讨小肠解旋转技术对术中局部解剖的改变及其在胰十二指肠切除术中的应用。结果病人解小肠旋转时间分别为30、15、15 min。消化道重建前恢复小肠旋转状态所需时间约5 min。小肠解旋转后,肠系膜上动脉自肠系膜上静脉左后侧易位到右后侧,胰十二指肠下动脉直接发自肠系膜上动脉右侧壁并水平向右走行;胰腺系膜直接发自肠系膜上动脉右侧并创造了一个水平面,从而方便胰腺系膜的完整切除。术中出血量分别在0.10、0.15、0.05L,均未输血。术后病理学检查提示后腹膜切缘阴性(1例姑息性手术除外),另2例淋巴结清扫总数均10枚。术后引流量偏大,中位值约0.3 L/d,引流管放置时间均在1周以上。结论通过小肠解旋转技术简化胰腺系膜的解剖,可获得良好的手术视野,从而使得胰腺系膜切除变得容易、精确和可控。
[Abstract]:Objective to explore the technique of small intestinal rotation and its application in pancreaticoduodenectomy. Methods the data of 3 patients undergoing pancreaticoduodenectomy in Zhongshan Hospital affiliated to Fudan University from August 2016 to September 2016 were retrospectively analyzed. Combined with preoperative imaging data, postoperative pathological examination results and postoperative recovery, To investigate the changes of local anatomy of small intestine in operation and its application in pancreaticoduodenectomy. Results the rotation time of small intestine in patients was 30 ~ 15 ~ 15 minutes respectively. The time needed to restore the rotation state of small intestine before digestive tract reconstruction was about. 5 min.After the small intestine was decomposed and rotated, The superior mesenteric artery was translocated from the left and posterior sides of the superior mesenteric vein to the right posterior side, and the inferior pancreaticoduodenal artery came directly from the right wall of the superior mesenteric artery and went horizontally to the right. The pancreatic Mesangium comes directly from the right side of the superior mesenteric artery and creates a horizontal plane. It was convenient for complete excision of mesangium of pancreas. The amount of blood lost during the operation was 0.10 ~ 0.15 ~ 0.05L, respectively, without blood transfusion. Pathological examination showed that 1 case of palliative operation had negative margin of posterior peritoneum, and 10 of the other 2 cases had lymph node dissection. The median value is about 0.3 L / d, and the drainage tube is placed for more than one week. Conclusion to simplify the anatomy of the mesangium of the pancreas by the technique of small intestinal decompression and rotation, a good surgical field of vision can be obtained, thus making the excision of the mesangium of the pancreas easy, accurate and controllable.
【作者单位】：复旦大学附属中山医院普外科;
【基金】：上海市浦江人才计划(No.16PJD013) 国家自然科学基金项目(No.81272731)
【分类号】：R657.5

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