并发慢性胰腺炎的腹腔镜胰十二指肠切除术

Laparoscopic pancreatoduodenectomy complicated with chronic pancreatitis

并发慢性胰腺炎患者行LPD时,常规途径显露肠系膜上静脉(SMV)/门静脉通常较为困难,多途径肠系膜上动脉(SMA)优先入路结合结肠下入路顺行追踪SMV可保证该情况下LPD的安全实施。本例患者先行SMA后入路(较为容易显露SMA近端1/3),探查SMA根部有无受到肿瘤侵犯,首先判断可否行根治性手术或者是否需行动脉的切除重建;联合SMA前入路(较为容易显露SMA远端2/3),在离断钩突供血动脉的同时,为肠系膜上静脉后续的裸化或者切除重建暴露出充分的手术空间。结肠下入路从足侧向头侧顺行追踪SMV,可避免强行分离胰颈部重度粘连区导致的SMV损伤。

It is usually difficult to expose superior mesenteric vein(SMV)/portal vein by conventional approach in patients with chronic pancreatitis.Multiple superior mesenteric artery(SMA)approach combined with inferior colon approach can ensure the safety of LPD in this case.In this case,the posterior approach of SMA(1/3 of proximal SMA is easy to be exposed)was used to detect whether the root of SMA was invaded by tumor,and the radical operation or arterial resection and reconstruction was first judged.Then combined with the anterior approach of SMA(2/3 of distal SMA is easy to be exposed)to disconnect the feeding artery of uncinate process,meanwhile the sufficient operation space was exposed for the subsequent naked or resection and reconstruction of superior mesenteric vein.SMV can be traced anterogradely from the foot to the head through the subcolonic approach,which can avoid the injury of SMV caused by forcibly separating the severe adhesion area of the pancreatic neck.