“Total arterial devascularization first” technique for resection of pancreatic head cancer during pancreaticoduodenectomy
“Total arterial devascularization first” technique for resection of pancreatic head cancer during pancreaticoduodenectomy
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DOI：
10.1007/s11596-013-1181-0
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发表时间：
2013-10
期刊：
影响因子：
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通讯作者：
F. Peng;Min Wang;F. Zhu;Rui Tian;Chengjian Shi;Meng Xu;Xin Wang;Ming Shen;Jun X Hu;S. Peng;R. Qin
中科院分区：
文献类型：
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作者：
F. Peng;Min Wang;F. Zhu;Rui Tian;Chengjian Shi;Meng Xu;Xin Wang;Ming Shen;Jun X Hu;S. Peng;R. Qin
胰头完整切除术是胰头癌根治性切除术中最困难的一步，对于门静脉（PV）和上级肠系膜静脉（SMV）受肿瘤侵犯或压迫的患者。本文介绍了一种新的理念和技术--在分离静脉前，胰头的三条动脉血供被阻断。关键步骤包括通过完全横切上级肠系膜动脉（SMA）和胰腺肠系膜之间的神经和结缔组织暴露腹主动脉（AA）的前表面，并从SMA起点至腹腔干根部横切肠系膜。从2012年1月至2013年5月，共有58例PV/SMV浸润或压迫患者使用该技术接受了RPD。中位手术时间为5.1 h（范围4.5-8.1 h）。术中失血量中位数为450 mL（范围200-900 mL）。术中、术后无胰头区出血。58例患者中，21例行血管外侧壁切除或吻合术，10例行血管切除端端吻合术。术后出血、胰瘘和胆瘘的发生率分别为5.2%、6.8%和1.7%。术后3个月无死亡病例。TADF技术是治疗复杂RPD的一种新方法，可提高手术安全性，减少术中出血，有望成为RPD的标准化手术入路。
Integrated resection of the pancreatic head is the most difficult step in radical pancreaticoduodenectomy (RPD) in patients with the portal vein (PV) and superior mesenteric vein (SMV) invasion or oppression by the tumor. This study introduced a new idea and skill named the “total arterial devascularization first” (TADF) technique and its applications in RPD. Three arterial blood supplies of pancreatic head were obstructed before dissection of veins. The critical steps included exposure of the anterior surface of the abdominal aorta (AA) by completely transecting neural and connective tissue between superior mesenteric artery (SMA) and pancreatic mesounsinate, and transection of the mesounsinate from the origin of SMA to the root of the celiac trunk. From January 2012 through May 2013, a total of 58 patients with PV/SMV invasion or oppression underwent RPD using this technique. The median operative time was 5.1 h (ranging 4.5–8.1 h). The median intraoperative blood loss was 450 mL (ranging 200–900 mL). No intraoperative and postoperative bleeding of pancreatic head region occurred. Among the 58 patients, 21 were subjected to vessel lateral wall angiectomy or angiorrhaphy, and 10 to angiectomy and end-to-end anastomosis. The incidence of postoperative bleeding, postoperative pancreatic fistula and biliary fistula was 5.2%, 6.8%, and 1.7%, respectively. No patients died 3 months after operation. The TADF technique is a new method for intricate RPD and could improve the security of surgery and reduce intraoperative bleeding, which is expected to become standardized surgical approach for RPD.