规范化实施胰十二指肠切除术几个关键问题

Essentials of the standardized procedures for pancreaticoduodenectomy

胰十二指肠切除术是腹部外科最复杂的术式之一,在切除和重建两方面均极具挑战性。目前,其已作为常规术式在临床普遍开展,应重视规范化实施这一手术。须严格掌握手术指征;判断生物学可切除性;不推荐常规术前减黄;尽量术前、术中获得病理学依据;根据解剖部位和肿瘤生物学行为确定清扫范围;在保证切缘阴性的前提下,静脉受侵时应积极考虑联合血管切除;选择术者自身熟悉的吻合方式,吻合质量比方法更重要;建议常规留置引流管。

Pancreaticoduodenectomy （PD） is one of the most complicated procedure in abdominal surgery, which is challengeable in terms of resection and reconstruction. PD was performed currently as one of the routine procedure and it was emphasized that how to perform it with standardization. Surgical indication should be selected strictly, evaluation of biological respectability was needed, routine pre-operative biliary drainage was not recommended, try to obtain pathological results pre-operatively ＆ intra-operatively and to confirm extent of lymphadenectomy according to location ＆ biological behavior of the tumors, combined vascular resection could be considered when veins were involved if the negative margin was available, try to select the familiar ways of reconstruction for the operator, the quality of anastomosis is more important than the method itself, abdomimal drains were recommended to place.