Intestinal derotation procedure for facilitating pancreatoduodenectomy
Intestinal derotation procedure for facilitating pancreatoduodenectomy
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DOI：
10.1016/j.surg.2015.11.014
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发表时间：
2016-05-01
期刊：
影响因子：
3.8
通讯作者：
Mori, Toshiyuki
中科院分区：
文献类型：
--
作者：
Sugiyama, Masanori;Suzuki, Yutaka;Mori, Toshiyuki
背景在胰十二指肠切除术（PD）中，胰十二指肠下动脉（IPDA）的中胰腺切除和分离在技术上是困难的，因为胚胎发育期间发生的肠旋转导致的复杂解剖结构。我们发展了一种肠去旋转术，以便于中胰腺切除。回顾性比较去旋转术与传统手术治疗PD的围手术期因素。整个小肠和右半结肠从腹膜后游离，肠旋转减少。该手术简化了解剖学情况，其中（1）中胰腺在水平面上从上级肠系膜动脉（SMA）的右侧伸展，（2）IPDA从SMA的右壁产生，以及（3）SMA位于上级肠系膜静脉的右后侧。回顾性分析232例PD患者中去旋转组（n = 117）和传统手术组（n = 115）的围手术期因素。与传统手术相比，去旋转手术显著缩短了手术时间（434 vs 516分钟）和失血量（521 vs 908 mL），并倾向于增加RO切除率（90% vs 78%）。去旋转组有明显较高的早期发生率，即在引流静脉分裂前，IPDA分裂。两组术后并发症发生率无差异。去旋转手术是一种简单但有用的技术，有助于PD期间的中胰腺切除和早期IPDA分离。
Background. In pancreatoduodenectomy (PD), mesopancreas excision with division; of the inferior pancreatoduodenal artery (IPDA) is technically difficult because of the complex anatomy resulting from intestinal rotation occurring during embryological development. We have developed an intestinal derotation procedure for facilitating mesopancreas excision. The perioperative factors of PD were retrospectively compared between our derotation and the conventional procedure.Methods. The entire small intestine and right colon are mobilized from the retroperitoneum, and intestinal rotation is reduced. This procedure simplifies the anatomic situation, in which (1) the mesopancreas stretches from the right side of the superior mesenteric artery (SMA) in a horizontal plane, (2) the IPDA arises from the right wall of the SMA, and (3) the SMA is situated at the right-posterior side of the superior mesenteric vein. In 232 cases undergoing PD, perioperative factors were compared retrospectively between the derotation (n = 117) and conventional (n = 115) procedure groups.Results. The derotation procedure significantly decreased operative time (434 vs 516 minutes) and blood loss (521 vs 908 mL), and tended to increase the rate of RO resection (90% vs 78 %), compared with the conventional procedure. The derotation group had a significantly higher incidence of early, that is, before division of the drainage vein, IPDA division. Postoperative complication rates did not differ, between the 2 groups.Conclusion. The derotation procedure is a simple but useful technique that facilitates mesopancreas excision and early IPDA division during PD.