肝胰十二指肠系膜概念的基础与临床思考

The Basic and Clinical Thinking of the Concept of Mesohepatopancreaticoduodenum(MHPD)

全直肠系膜切除术、完整结肠系膜切除术术式的提出给患者带来了术后生存率的提高。近期笔者于术中以及间接的临床证据推测肝胰十二指肠系膜的存在,并结合胚胎学和解剖学提出假设及概念。笔者认为胰腺前后有完整的筋膜包绕,向上延续至肝十二指肠,向下终结于横结肠系膜前叶,向左至十二指肠,向右至脾,形成以腹腔干血管为核心的筋膜组织。并希望由此带来临床术式的改变及肿瘤患者生存率的提高。

Total mesorectal excision（TME）and complete mesocolic excision（CME）have brought forward improving survival of patients after operation.Recently,we speculate on the re-understanding of the fascia about liver,pancreas,duodenum based on operation observation,indirect clinical evidence includes embryology and anatomy.So the hypothesis and concept of mesohepatopancreaticoduodenum（MHPD）was put forward.We think that there probably are complete fascia around pancreas,which extend to hepatoduodenal ligament upward,down to the transverse mesocolon,left to the spleen and right to the duodenum and the celiac trunk was the core of the MHPD.This concept will contribute to the transformation of the clinical operation mode and finally increase survival rate of corresponding patients.