胰十二指肠切除术手术入路探讨与评价

Evaluation of surgical approaches of pancreaticoduodenectomy

近10年来,胰十二指肠切除术(PD)不断改进,如动脉先行入路、无接触技术入路等,对提高R0切除率、降低术中风险有一定的帮助。手术入路选择须根据病人情况、肿瘤部位、血管侵犯程度、术者经验等个体化综合考虑。目前,PD主要的手术入路包括标准入路、无接触技术入路、横结肠系膜下方入路、胰头区流入动脉先行离断入路、动脉先行入路、钩突先行入路等。传统入路PD仍是基础与标准。对于较大的胰腺外科中心和具有比较丰富胰腺手术经验的术者,为达到有效提高R0切除率和降低术中风险的目的,须灵活运用各种不同入路技术。

In the past ten years, some new techniques of the pancreatoduodenectomy（PD）, which is represented by the artery- first approach and no-touch technique, has a certain help to improve the R0 resection rate and reduce the risk during operation. The choice of surgical approach should be based on individual comprehensive consideration of patients, tumor location, vascular invasion, and technical experience of the surgeons. The PD surgical approaches included standard approach, no-touch technique, below the transverse mesocolon approach, early ligation of the efferent arteries of the head of pancreas, artery first approach, uncinate process first approach etc. Traditional approach PD is still the foundation and standard. For the large pancreatic surgery centers and experienced pancreatic surgeons, they should use the different approaches properly to improve the R0 resection rate and to reduce the operation risk.