腹腔镜下扩大淋巴结清扫的胰十二指肠切除术

Pancreaticoduodenectomy with laparoscopic extended lymph node dissection

行传统Kocher切口行腹膜后淋巴结清扫,距屈氏韧带5~10 cm离断空肠,离断远端2/3胃体,肝十二指肠韧带骨骼化清扫,离断GDA,离断胰颈,清扫肝总动脉及腹腔干周围淋巴结,解剖SMA-CT系统,行SMA左右侧360°清扫,完成钩突全系膜切除,切除胆囊,最后离断肝总管。标准清扫+8P、9、12a、12P、14c-d、16a2、16b1的扩大淋巴结清扫。胰肠吻合采用创新的“两点法”胰管导管-黏膜吻合,胆肠吻合采取连续缝合,直线切割闭合器行胃后壁与空肠侧侧吻合。

To perform the traditional Kocher maneuver for retroperitoneal lymph node dissection.Transect the jejunum 5-10 cm away from the ligament of Treitz,transect the distal 2/3 of gastric body,to dissect and skeletonize the hepatoduodenal ligament,to cut off the GDA,and pancreatic neck.Then to dissect the lymph nodes around common hepatic artery and celiac trunk.To divide the SMA-CT system and to dissect its right and left side around 360.Remove the total mesentery of pancreatic uncinate process.To resect the gallbladder and transect the common hepatic duct finally.To check the surgical site with extended lymph node dissection of 8p 912a 12p 14c-d 16a216b1 groups.Pancreaticojejunostomy was performed by using innovative“two-point”pancreatic duct-mucosal anastomosis.Choledochojejunostomy was performed by Continuous suture.Gastrointestinal anastomosis was performed with Endo-GIA.