腹腔镜视角下胰十二指肠上前静脉解剖分型研究

Study on anatomical classification of the superior anterior pancreaticoduodenal vein under the laparoscopic view

目的分析总结腹腔镜视角下胰十二指肠上前静脉(ASPDV)的解剖学分型及其特点,并分析其临床意义。方法通过复习手术视频和手术记录,回顾性研究2015年1月至2022年6月期间在北京大学第一医院接受腹腔镜右半结肠癌根治术的211例病人的ASPDV解剖学特点,以及手术时间和术中出血量。结果腹腔镜视角下,按ASPDV回流解剖部位分为3型:Ⅰ型为ASPDV仅汇入Henle干者,占83.9%(177/211);Ⅱ型为ASPDV仅汇入肠系膜上静脉(SMV)者,占11.4%(24/211);Ⅲ型为ASPDV同时分别回流至Henle干和SMV者,占4.7%(10/211)。根据ASPDV属支数目,将Ⅰ型进一步分为3个亚型:Ⅰa亚型,回流入Henle干的ASPDV分支为1支,占72.5%(153/211);Ⅰb亚型,回流入Henle干的ASPDV分支为2支,占9.0%(19/211);Ⅰc亚型,回流入Henle干的ASPDV分支为3支及以上,占2.4%(5/211)。同时,ASPDV汇入Henle干者(包括Ⅰ型和Ⅲ型),共计187例,根据ASPDV汇入的解剖位置,又可分为近心端汇入型(95.2%,178/187)和远心端汇入型(4.8%,9/187)。Ⅰb亚型+Ⅰc亚型+Ⅲ型病人与Ⅰa亚型+Ⅱ型病人比较,解剖Henle干的时间较长[(29.2±4.4)min vs.(21.6±5.6)min,t=7.5,P<0.001],术中出血量较多[25(20,50)mL vs.20(20,30)mL,U=2084,P=0.002]。远心端汇入型病人与近心端汇入型病人相比,解剖Henle干的时间较长[(32.5±5.9)min vs.(22.4±5.8)min,t=4.8,P<0.001],术中出血量较多[50(20,50)mLvs.20(20,30)mL,U=465,P=0.02]。结论根据腹腔镜视角下ASPDV的不同分型,Ⅰa型和近心端汇入型为临床中最常见类型。存在多个分支的APSDV类型和远心端汇入型ASPDV手术时间较长、出血风险较高。

Objective To summarize the anatomical classification and characteristics of the superior anterior pancreaticoduodenal vein(ASPDV)under the laparoscopic view,and to analyze their clinical significance.Methods By reviewing recorded surgical videos and surgical records,the anatomical variations of ASPDV from 211 patients who underwent laparoscopic radical right hemicolectomy in Peking University First Hospital between January 2015 and June 2022 were retrospectively studied.Besides,the operation time and intraoperative blood loss were analyzed.Results Three types of ASPDV were classified according to the anatomical reflux site of ASPDV under the laparoscopic view:typeⅠ,in which ASPDVs were only draining into Henle trunk,as the most common type,accounting for 83.9%(177/211);typeⅡ,in which ASPDVs were only draining into the superior mesenteric vein(SMV),accounting for 11.4%(24/211);TypeⅢ,in which ASPDVs were draining both into Henle trunk and SMV respectively,accounting for 4.7%(10/211).For typeⅠ,subtypes were defined according to the branch numbers of the ASPDVs:subtypeⅠa,with one ASPDV branch draining into Henle trunk,accounting for 72.5%(153/211);subtypeⅠb,with two ASPDV branches draining into Henle trunk,accounting for 9.0%(19/211);subtypeⅠc,with three or more ASPDV branches draining into Henle trunk,accounting for 2.4%(5/211).According to the confluence site of the ASPDV and Henle trunk,both of typeⅠand typeⅢ,in which ASPDVs were draining into Henle trunk involving 187 cases,were further subtyped into proximal convergence(95.2%,178/187)and distal convergence(4.8%,9/187).Compared with subtypeⅠa+typeⅡpatients,subtypeⅠb+subtypeⅠc+typeⅢpatients had a longer operation time[(29.2±4.4)min vs.(21.6±5.6)min,t=7.5,P<0.001]and more intraoperative blood loss[25(20,50)mL vs.20(20,30)mL,U=2084,P=0.002].In addition,compared with proximal convergence type patients,the distal convergence type patients had longer operation time[(32.5±5.9)min vs.(22.4±5.8)min,t=4.8,P<0.001]and more intraoperative blood loss[50(20,50)mL vs.20(20,30)mL,U=465,P=0.02].Conclusion Based on the different types of ASPDV under the laparoscopic view,type I a and proximal convergence type are the most common type in the clinic.APSDV with multiple branches or distal convergence type had longer operation time and a higher risk of bleeding.