Left posterior approach to the superior mesenteric vascular pedicle in pancreaticoduodenectomy for cancer of the pancreatic head.
Left posterior approach to the superior mesenteric vascular pedicle in pancreaticoduodenectomy for cancer of the pancreatic head.
复制标题
胰头癌胰十二指肠切除术中肠系膜上血管蒂的左后入路。
作者：
I. Kurosaki;M. Minagawa;Kabuto Takano;K. Takizawa;K. Hatakeyama
上下文
上级肠系膜动脉的分离是胰腺癌胰管切除术中最重要的部分。自2005年以来，我们采用左后侧入路进行上级肠系膜血管蒂剥离，首先顺时针剥离上级肠系膜动脉和上级肠系膜静脉。
目的
本文介绍了左后侧入路的技术和临床结果。
患者
40例患者接受了左后侧入路，并与35例采用传统夹层治疗的患者进行了比较。
主要观察指标
描述了左后入路与传统方法之间的手术技术差异，并对接受左后入路与传统方法治疗的患者进行了短期和长期手术结果比较。
干预
首先从上级肠系膜动脉的左侧缘解剖出上级肠系膜血管蒂。还从左侧解剖了上级肠系膜静脉。然后，将钩突和血管周围软组织与血管系统整体分离。
结果
使用左后入路行胰管切除术后未发生危及生命的并发症。65%的患者发生腹泻，需要给予抗腹泻药物;然而，所有未出现早期肿瘤复发的患者均完成了计划的辅助化疗。术后3年生存率为52.8%。
结论
在左后入路胰管切除术后，大多数患者出现不同程度的腹泻，但在密切监测下，辅助化疗能够继续进行。左后侧入路有助于了解上级肠系膜血管蒂的局部解剖。
CONTEXT
Dissection of the superior mesenteric artery is the most important part of a pancreaticoduodenectomy for pancreatic cancer. Since 2005, we have used the left posterior approach for superior mesenteric vascular pedicle dissection, in which the superior mesenteric artery and the superior mesenteric vein are dissected first in a clockwise fashion.
OBJECTIVE
This article presents the technique of a left posterior approach and the clinical outcome.
PATIENTS
Forty patients underwent a left posterior approach and were compared to 35 patients treated with a conventional dissection.
MAIN OUTCOME MEASURES
The differences in surgical technique between the left posterior approach and the conventional method were described, and the short- and long-term surgical results compared patients who underwent the left posterior approach to those who were treated with the conventional method.
INTERVENTION
The superior mesenteric vascular pedicle was first dissected from the left lateral border of the superior mesenteric artery. The superior mesenteric vein was also dissected from the left side. Then, the uncinate process and perivascular soft tissue were separated en bloc from the vasculature.
RESULTS
No life-threatening complications occurred after the pancreaticoduodenectomies using a left posterior approach. Diarrhea requiring the administration of antidiarrheal agents occurred in 65% of patients; however, planned adjuvant chemotherapy was completed in all patients who did not have an early tumor recurrence. Survival rate was 52.8% at 3 years after surgery.
CONCLUSION
After a pancreaticoduodenectomy with a left posterior approach, most patients had various degrees of diarrhea, but the adjuvant chemotherapy was able to be continued with close monitoring. The left posterior approach facilitates understanding of the topographic anatomy in the superior mesenteric vascular pedicle.
影响因子：
9
作者：
Yeo, CJ;Cameron, JL;Lillemoe, KD
通讯作者：
Lillemoe, KD