Shukla P J, Barreto G, Pandey D, Kanitkar G, Nadkarni M S, Neve R, Shrikhande S V
Department of Gastrointestinal and Hepatopancreatobiliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
Hepatogastroenterology. 2007 Sep;54(78):1728-30.
Pancreaticoduodenectomy remains the recommended procedure for periampullary and pancreatic head tumors. The dissection of the uncinate process from the superior mesenteric vessels is a key step in this surgery. We describe a modification in the existing practice of infracolic division of the jejunum in order to facilitate this step. In this modification, the duodenojejunal (DJ) flexure and the proximal jejunum are delivered into the supracolic compartment and then the jejunum is divided. This exposes the uncinate process completely and facilitates the separation from the Superior Mesenteric Artery (SMA) and the Superior Mesenteric Vein (SMV). We have successfully employed this modified technique for 33 resections since February 2004. This modification of dividing the jejunum in the supracolic compartment is based on sound anatomic and embryologic grounds. It helps in aligning the uncinate process with the jejunal mesentery thereby making the dissection of uncinate process from the superior mesenteric vessels safe and complete.
胰十二指肠切除术仍然是壶腹周围和胰头肿瘤的推荐手术方式。从肠系膜上血管游离钩突是该手术的关键步骤。我们描述了一种对空肠结肠下部分现有操作的改良方法，以利于这一步骤。在这种改良方法中，将十二指肠空肠（DJ）曲和近端空肠提入结肠上区，然后再切断空肠。这样可完全暴露钩突，便于从肠系膜上动脉（SMA）和肠系膜上静脉（SMV）分离。自2004年2月以来，我们已成功地将这种改良技术应用于33例切除术。这种在结肠上区切断空肠的改良方法基于合理的解剖学和胚胎学依据。它有助于使钩突与空肠系膜对齐，从而使从肠系膜上血管分离钩突安全且彻底。
