联合门静脉-肠系膜上静脉切除重建的腹腔镜胰十二指肠切除术关键技术环节

Laparoscopic pancreaticoduodenectomy with venous resection and reconstruction:techniques and tips

联合门静脉-肠系膜上静脉的胰十二指肠切除术可使部分血管侵犯病人可获得根治性手术机会并能从手术中获益。随着技术进步,联合门静脉-肠系膜上静脉切除重建的腹腔镜胰十二指肠切除术已在国内外少数中心开展,国内外多项回顾性研究结果证实该术式在围手术期是安全可行的。针对伴有肿瘤侵犯门静脉-肠系膜上静脉的腹腔镜胰十二指肠切除术,术前精准评估、合适的肠系膜上动脉入路、手术流程、合理的血管切除重建方式以及重建血管通畅性的术中评估是该技术的关键环节。由经验较为丰富的胰腺微创外科医师以及在较大的胰腺外科中心开展该技术能够大大提高该技术围手术期的安全性,该技术已从技术挑战阶段进入了更为规范合理的、以胰腺微创外科手术为主导的多学科综合治疗阶段。该技术对胰腺恶性肿瘤治疗的安全性与有效性,仍需要更多的随机、前瞻性的、大样本、多中心的高质量研究来证明。

Pancreaticoduodenectomy with venous resection and reconstruction makes the patients with venous invasion enable to get benefits from surgery.With the advancement of technology,Laparoscopic pancreaticoduodenectomy withvenous resection and reconstruction develop rapidly and hasbeen carried out in some centers.Some retrospective studieshave confirmed that this operation is safe and feasible in theperioperative period.Accurate preoperative evaluation,superior mesenteric artery(SMA)approach,surgical procedure,reasonable vascular resection and reconstruction methods,andevaluation of the vascular patency are the tips of thistechnique.Experienced minimally invasive surgeons of high-volume centers can greatly improve the safety of thistechnique.The multidisciplinary approach affords the besthope for improved outcomes in patients with pancreatic cancerand the treatment for pancreatic cancer develops morereasonable and regulated.Further trials are needed to evaluatethe role of neoadjuvant treatment and the application of thelaparoscopic approach in patients with major venous whoanswered on treatment.