Artery-First Distal Pancreatectomy
Artery-First Distal Pancreatectomy
复制标题
动脉优先远端胰腺切除术
DOI：
10.1159/000445016
复制
发表时间：
2016
影响因子：
2.7
通讯作者：
S. Uemoto
中科院分区：
文献类型：
--
作者：
K. Takaori;S. Uemoto
动脉优先胰腺切除术是一种在胰腺分割前结扎供血动脉的技术，旨在减少失血并进行更多的肿瘤切除;例如，动脉优先远端胰腺切除术（DP）首先结扎脾动脉（SA）。动脉先行DP的潜在优点包括在可能累及SA和/或腹腔动脉的胰腺癌情况下早期确定可切除性。然而，由于难以暴露SA的起源，特别是在开放手术中，动脉先行DP很少进行。通过腹腔镜DP的经验，我们已经开发出一种技术的动脉第一DP的“Tora-no-Ana”的方法，其中包括后部解剖的胰体通过分裂的Treitz韧带。胰腺实质与SA和静脉的悬挂操作是成功的动脉优先DP的另一个关键。通过悬吊操作，SA的起源可以很好地可视化，并通过开放、腹腔镜或机器人方法清楚地识别，从而可以实现肿瘤切除。总之，在遵循Tora-no-Ana入路和胰体悬吊术的手术原则下，动脉先行DP是安全可行的。
Artery-first pancreatectomy is a technique to ligate the feeding artery before the division of the pancreas with intents to reduce the blood loss and to perform more oncologic resection; for example, the splenic artery (SA) is ligated first for artery-first distal pancreatectomy (DP). Potential merits of artery-first DP include early determination of resectability in the setting of pancreatic cancer with possible involvement of SA and/or celiac artery. However, due to difficulties in exposing the origin of SA, especially in open surgery, artery-first DP has been rarely performed. Through the experience of laparoscopic DP, we have developed a technique of artery-first DP by the ‘Tora-no-Ana' approach, which consists of posterior dissection of the pancreatic body thorough a division of the ligament of Treitz. A hanging maneuver of the pancreatic parenchyma with SA and vein is another key for a successful artery-first DP. By the hanging maneuver, the origin of SA is well visualized and clearly identified either by open, laparoscopic or robotic approach so that oncologic resection can be achieved. In conclusion, artery-first DP is safe and feasible if the surgical principals by the Tora-no-Ana approach and hanging maneuver of the pancreatic body are adhered.