Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy
Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy
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DOI：
10.1007/s00464-018-6118-z
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发表时间：
2018-09-01
影响因子：
3.1
通讯作者：
Tsuchida, Akihiko
中科院分区：
文献类型：
--
作者：
Nagakawa, Yuichi;Hosokawa, Yuichi;Tsuchida, Akihiko
背景虽然动脉优先入路被广泛应用于胰十二指肠切除术，但腹腔镜很难从肠系膜上动脉（SMA）左侧暴露胰十二指肠下动脉（IPDA）的起源。相反，当从SMA右侧接近IPDA时，可能会损伤胰十二指肠下静脉（IPDVs）。为了方便腹腔镜胰十二指肠切除术（LPD）的动脉优先入路，我们重点研究了从肠系膜上静脉（SMV）背侧分支的空肠近背静脉（PDJV）并引流ipdv。本研究旨在阐明使用PDJV预分离方法的正确SMA入路的有效性。方法首先分离PDJV，沿SMA右侧PDJV分离ipdv。然后，在不首先将胰头与门静脉和SMV分离的情况下，从根部分离IPDA。总的来说，21名患者接受了这种入路，并将结果与21名接受动脉优先入路的患者的结果进行回顾性比较，后者在SMA左侧进行。采用多探测器计算机断层扫描对两组患者的PDJV解剖特征进行评估。结果PDJV预分离组的手术时间和切除时间明显低于常规LPD组（分别为489.3 min和541.7 min, p=0.002）。在解剖评估中，41例（97.6%）患者的PDJV从SMV背侧流出，并与钩状突的前部接触。31例（73.8%）为第一空肠静脉，10例（23.8%）为第二空肠静脉。结论该入路有利于SMA右侧IPDA的剥离，从而减少手术时间。
Background Although the artery-first approach is widely used in open pancreaticoduodenectomy, it is difficult to laparoscopically expose the origin of the inferior pancreaticoduodenal artery (IPDA) from the left side of the superior mesenteric artery (SMA). By contrast, damaging the inferior pancreaticoduodenal veins (IPDVs) is possible when approaching the IPDA from the right side of the SMA. To facilitate the artery-first approach in laparoscopic pancreaticoduodenectomy (LPD), we focused on the proximal-dorsal jejunal vein (PDJV) that branched from the superior mesenteric vein (SMV) dorsal side and drained the IPDVs. This study aimed to clarify the usefulness of the right SMA approach using the PDJV preisolation method.Methods The PDJV was first isolated, and the IPDVs were divided along the PDJV on the right side of the SMA. Then, the IPDA was divided at the root without first separating the pancreatic head from the portal vein and the SMV. Overall, 21 patients underwent this approach, and the results were retrospectively compared with those of 21 patients who underwent the artery-first approach, which was performed on the left side of the SMA. Anatomical characteristics of the PDJV were evaluated using multidetector computed tomography for the two groups.Results Operative times and resection times were significantly lower for the PDJV preisolation group than for the conventional LPD group (489.3 vs. 541.7 min, respectively; p=0.002). During anatomical evaluation, 41 patients (97.6%) had a PDJV that drained from the SMV dorsally and was in contact with the anterior aspect of the uncinate process. The PDJV was confirmed as the first jejunal vein in 31 patients (73.8%) and as the second jejunal vein in 10 patients (23.8%).Conclusions This approach facilitates dissection of the IPDA on the right side of the SMA, thereby reducing operative times.