Kurosaki Isao, Minagawa Masahiro, Takano Kabuto, Takizawa Kazuyasu, Hatakeyama Katsuyoshi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences. Niigata, Japan.
JOP. 2011 May 6;12(3):220-9.
Dissection of the superior mesenteric artery is the most important part of a pancreaticoduodenectomy for pancreatic cancer. Since 2005, we have used the left posterior approach for superior mesenteric vascular pedicle dissection, in which the superior mesenteric artery and the superior mesenteric vein are dissected first in a clockwise fashion.
This article presents the technique of a left posterior approach and the clinical outcome.
Forty patients underwent a left posterior approach and were compared to 35 patients treated with a conventional dissection.
The differences in surgical technique between the left posterior approach and the conventional method were described, and the short- and long-term surgical results compared patients who underwent the left posterior approach to those who were treated with the conventional method.
The superior mesenteric vascular pedicle was first dissected from the left lateral border of the superior mesenteric artery. The superior mesenteric vein was also dissected from the left side. Then, the uncinate process and perivascular soft tissue were separated en bloc from the vasculature.
No life-threatening complications occurred after the pancreaticoduodenectomies using a left posterior approach. Diarrhea requiring the administration of antidiarrheal agents occurred in 65% of patients; however, planned adjuvant chemotherapy was completed in all patients who did not have an early tumor recurrence. Survival rate was 52.8% at 3 years after surgery.
After a pancreaticoduodenectomy with a left posterior approach, most patients had various degrees of diarrhea, but the adjuvant chemotherapy was able to be continued with close monitoring. The left posterior approach facilitates understanding of the topographic anatomy in the superior mesenteric vascular pedicle.
肠系膜上动脉的解剖是胰腺癌胰十二指肠切除术最重要的部分。自2005年以来，我们采用左后入路进行肠系膜上血管蒂解剖，即先按顺时针方向解剖肠系膜上动脉和肠系膜上静脉。
本文介绍左后入路技术及临床结果。
40例患者采用左后入路，并与35例采用传统解剖方法的患者进行比较。
描述左后入路与传统方法在手术技术上的差异，并比较采用左后入路患者与采用传统方法患者的短期和长期手术结果。
首先从肠系膜上动脉左侧缘开始解剖肠系膜上血管蒂。肠系膜上静脉也从左侧进行解剖。然后，将钩突和血管周围软组织与血管系统整块分离。
采用左后入路进行胰十二指肠切除术后未发生危及生命的并发症。65%的患者出现需要使用止泻药的腹泻；然而，所有未早期肿瘤复发的患者均完成了计划的辅助化疗。术后3年生存率为52.8%。
采用左后入路进行胰十二指肠切除术后，大多数患者出现不同程度的腹泻，但在密切监测下能够继续进行辅助化疗。左后入路有助于理解肠系膜上血管蒂的局部解剖结构。
