腹腔镜下肠系膜上动脉优先入路扩大清扫的胰十二指肠切除术(en-bolc)

Laparoscopic en-bolc extended pancreaticoduodenectomy with superior mesenteric artery-first approach

胰头癌除了血行和淋巴转移外,还极易发生神经侵犯,标准的胰十二指肠切除术无法做到胰腺周围神经丛的清扫。目前对于胰头癌行联合胰腺周围神经从扩大清扫的手术指征和清扫范围尚无统一的规范标准,我们中心在王槐志教授的带领下已经进行了10余年扩大清扫的胰十二指肠切除术治疗胰头癌,手术要求对胰头后方、肠系膜上动脉及腹腔干和肝总动脉周围进行360°完整的骨骼化清扫。近年来腹腔镜胰十二指肠切除术发展迅速,我们中心腹腔镜下根治性胰十二指肠切除术治疗胰头癌按照开腹扩大清扫的标准,采用肠系膜上动脉优先人路,优先结扎切断胰十二指肠下动脉,切断了胰头的动脉血供再处理肠系膜上静脉和门静脉支,减少了出血,并且实现了病变和后腹膜神经淋巴组织的整体切除。

In addition to hematogenous and lymphatic metastasis.pancreatic head cancer is also prone to nerve invasion.The standard pancreaticoduodenectomy cannot achieve a clearance of the nerve plexus around the pancreas.Currently,there is no unified standard for the surgical indications and scope of the extended pancreaticoduodenal.Under the guidance of Professor Wang Huaizhi,our center has been performing extended pancreaticoduodenectomy for the treatment of pancreatic head cancer for more than 10 years.The procedure requires a complete skeletonization clearance of the posterior aspect of the pancreatic head,superior mesenteric artery.celiac trunk,and hepatic artery within a 360°range In recent years,laparoscopic pancreaticoduodenectomy has developed rapidly.Following the standards of open extended pancreaticoduodenectomy,our center performs laparoscopic extended pancreaticoduodenectomy with superior mesenteric artery-first approach for the treatment of pancreatic head cancer.During the procedure we ligate and cut off the inferior pancreaticoduodenal artery first,thereby cutting off the arterial blood supply to the pancreatic head.It then deals with the superior mesenteric vein and portal vein tributaries.reducing bleeding and achieving the complete removal of the lesion,retroperitoneal neural and lymphatic tissues.