Sharma Dhananjaya, Isaji Shuji
Department of Surgery, Government Medical College and Allied Hospitals, Jabalpur, Madhya Pradesh 482 003, India.
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
J Hepatobiliary Pancreat Sci. 2016 Dec;23(12):745-749. doi: 10.1002/jhbp.402. Epub 2016 Oct 12.
Focused pathological attention to tumor invasion of the retroperitoneal resection margin after pancreaticoduodenectomy for cancer of head of the pancreas led to the knowledge of strong tendency of cancer cells to infiltrate into the retropancreatic tissue and to spread along the peripancreatic neural plexuses as the cause of local recurrence. The term 'mesopancreas' was coined to describe perineural lymphatic layer located dorsally to the pancreas and it was suggested that its complete resection will minimize loco-regional recurrence and improve outcome. This catchy title and concept attracted the attention of surgeons and "total meso-pancreas excision" was introduced by 'artery first' or 'posterior first' surgical techniques to ensure 'en-bloc' extended resection of retropancreatic lymphatics. However, mesopancreas is a misnomer and cannot be called a 'true' mesentery as it does not have a fascial envelope attaching the pancreas to the posterior wall of the abdomen and does not contain 'all' its blood vessels and 'all' its primary draining lymphatics and lymph nodes. Japan Pancreas Society's description of pancreatic head plexus II is anatomically consistent with 'mesopancreas' and it should be renamed as such. This nomenclature clearly illustrates its exact anatomical location and surgical relevance; and stands up to necessary rigorous scientific scrutiny.
对胰头癌胰十二指肠切除术后腹膜后切缘肿瘤浸润进行有针对性的病理关注，使人们认识到癌细胞有强烈的倾向浸润到胰后组织并沿胰周神经丛扩散，这是局部复发的原因。“中胰”这一术语被创造出来描述位于胰腺背侧的神经周围淋巴层，并有人提出完整切除它将使局部区域复发最小化并改善预后。这个吸引人的标题和概念引起了外科医生的关注，“全中胰切除术”通过“动脉优先”或“后方优先”手术技术被引入，以确保“整块”扩大切除胰后淋巴管。然而，中胰是一个不恰当的名称，并不能被称为“真正的”系膜，因为它没有将胰腺附着于腹后壁的筋膜包膜，也不包含其“所有”血管以及“所有”主要引流淋巴管和淋巴结。日本胰腺学会对胰头丛II的描述在解剖学上与“中胰”一致，并应如此重新命名。这种命名法清楚地说明了其确切的解剖位置和手术相关性；并且经得起必要的严格科学审查。
