保留十二指肠、胆总管、Oddi’氏括约肌的胰头整块全切除术

Duodenum-CBD-Oddi’s Sphincter-preserving Pancreatic Head en bloc Total Resection(DCOPPHTR)

保留十二指肠、胆总管、Oddi’氏括约肌的胰头整块全切除术(DCOPPHTR)。这个术式是基于我们对慢性胰腺炎病理改变的新发现和对胰腺解剖结构的深刻理解。因此这个术式打破了Beger术式的原理,是一个新的手术方式。要点如下:(1)采用Kocher手术从后腹膜游离胰头直到看见肠系膜下静脉。(2)沿肠系膜上静脉解剖,结扎Henle干。(3)解剖胃十二指肠动脉,暴露门静脉主干。(4)切断胰颈前缝合胰腺上下缘、结扎切除线的近端以减少出血。(5)在胰腺勾突注水,沿胰腺实质解剖,确保不损伤胰腺后被膜。(6)沿着十二指肠和胰头之间的疏松结缔组织解剖,结扎到胰头的小动脉分支。(7)沿胰腺实质和胆总管之间解剖,切断主胰管,用5-0普理灵线连续缝合其残端。(8)胰腺吻合采用胰管对黏膜的吻合方式。

DCOPPHTR is based on our new discoveries on the pathological change of chronic pancreatitis and deeper understandings on the anatomy of pancreas.Therefore,DCOPPHTR breaks through Beger’s principles and is a new procedure The main points are as follows:(1)To separate pancreatic head from retroperitoneum by Kocher surgery until we see inferior mesenteric vein.(2)To dissect along SMV and ligate Henle trunk.(3)To dissect GDA and expose main trunk of portal vein.(4)Before cut off the pancreatic neck,we suture the lower and upper edge of pancreatic neck,ligate the proximal end of cut line to decrease bleeding.(5)To inject water into the uncinate of pancreas,dissect along parenchyma and keep the back capsule intact.(6)To dissect along loose connective tissue between duodenum and parenchyma of pancreatic head;ligate artery branches to pancreatic head.(7)To dissect between pancreatic parenchyma and common bile duct;cut off the main pancreatic duct and suture its stump using 5/0 pleiling thread.(8)Pancreaticojejunostomy was performed by duct to mucosa anastomosis.