扩大的胰头十二指肠切除术

Extended pancreatoduonectomy

胰头十二指肠切除手术一直是胰头癌切除的经典术式,但生物学特性导致胰头癌手术切除率低以及手术后复发率高,生存率低,在此基础上出现了以提高根治切除率为目的的扩大胰头十二指肠切除手术.本文结合最新文献阐述了扩大胰头十二指肠切除的病理生理基础,标准化手术范围,并结合自身经验阐述了扩大胰头十二指肠切除术进行淋巴结清扫、神经丛廓清、以及血管联合切除的适应证、手术技术和手术风险,明确了通过细致的手术解剖,扩大的胰头十二指肠切除并未增加手术风险同时显著提高了胰头癌的切除率.

Pancreatoduodenectomy remains a conventional procedure for pancreatic head cancer, however, it has been associated with high incidence of recurrence and low survival rate due to the specific characteristics of biological behavior of pancreatic head cancer, leading to the introduction of extended pancreatoduodenectomy with an attempt to improve the curative resection rate. With the latest literature review, this article presents the evidence for extended pancreatoduodenectomy from a pathological and anatomical point of view, and also described the standardized procedures, indications, and risk of extended pancreaticoduo- denectomy for lymphadenectomy, neural clearance and combined vascular resection. Extended pancreatoduodenectomy for pancreatic head cancer significantly improves resection rate but doesn＇t increase surgical risk.