Lupaşcu C, Ursulescu Corina, Dănilă N, Grigorean V, Târcoveanu E, Andronic D
Discipline of Surgery, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iaşi.
Discipline of Radiology, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2013 Jan-Mar;117(1):137-42.
Pancreaticoduodenectomy is the procedure of choice for tumors of the pancreatic head and periampullary region. During pancreaticoduodenectomy, early neck division may be inadequate in case of hepatic artery anatomic variants, suspected involvement of the superior mesenteric vessels or intraductal papillary mucinous neoplasms.
We describe our early approach to the superior mesenteric vessels during pancreaticoduodenectomy, by retroportal lamina dissection before pancreatic transection.
We used this approach in 41 patients. There were 28 patients with abnormal hepatic artery, which was spared in 26 cases. Hepatic artery reconstruction was required in 2 cases. Nine patients with intraductal papillary mucinous neoplasms underwent 6 pancreaticoduodenectomies extented to the body and 3 total pancreaticoduodenectomies. Four patients with adenocarcinoma involving the portomesenteric vein required pancreaticoduodenectomy with venous resection and reconstruction.
Early retropancreatic lamina dissection is useful way to tailor a pancreaticoduodenectomy which is recommended in selective indications.
胰十二指肠切除术是胰头和壶腹周围区域肿瘤的首选手术方式。在胰十二指肠切除术中，对于存在肝动脉解剖变异、怀疑肠系膜上血管受累或导管内乳头状黏液性肿瘤的情况，早期切断胰腺颈部可能并不充分。
我们描述了在胰十二指肠切除术中，在胰腺横断前通过门静脉后层解剖对肠系膜上血管采取的早期处理方法。
我们将此方法应用于41例患者。其中28例患者存在肝动脉异常，26例肝动脉得以保留，2例需要进行肝动脉重建。9例导管内乳头状黏液性肿瘤患者接受了6例扩大至胰体部的胰十二指肠切除术和3例全胰十二指肠切除术。4例腺癌累及门静脉肠系膜静脉的患者需要进行胰十二指肠切除术并联合静脉切除及重建。
早期胰腺后层解剖是一种为胰十二指肠切除术量身定制的有用方法，推荐在选择性适应证中应用。
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