Zheng Long-Zhi, Lin Guo-Wei, Zheng Chang-Yue, Guo Jian, Zu Bin, Huang Jian-Xin, Lin Wei
Department of Gastrointestinal Surgery and Gastrointestinal Surgery Research Institute, the Affiliated Hospital of Putian University, Putian, China.
Department of Urinary Surgery, the Affiliated Hospital of Putian University, Putian, China.
Wideochir Inne Tech Maloinwazyjne. 2019 Sep;14(3):374-380. doi: 10.5114/wiitm.2019.81442. Epub 2019 Jan 22.
The traditional laparoscopic surgery is difficult to deal with the deep lesions of the body and tail of the pancreas, which may damage the visceral organs of the abdominal cavity and cause abdominal adhesion and other related complications.
This paper introduces the operation procedure of retroperitoneoscopy in pancreatic surgery, and evaluates its feasibility in clinical application.
Retrospective analysis was performed on patients with retroperitoneal pancreatectomy in our hospital. The anatomical features of the fascia, surgical plane composition and surgical pathway of the fascia of the retroperitoneoscopic pancreatectomy were observed during the operation, and the surgical safety and feasibility were analyzed. The following parameters were evaluated: operation time, blood loss, pancreatic fistula, postoperative gastro-intestinal recovery, hospital stay.
All 3 patients had a smooth operation and no serious complications occurred. During retroperitoneal laparoscopic pancreatectomy, there is a vascularized plane between the posterior fascia of the pancreas and the prerenal fascia, which can avoid injury of the visceral organs and retroperitoneal vessels. The anterior renal fascia should be used as the posterior boundary of the safe separation plane.
The surgical plane based on the anatomy of the fascia and interstitial dissection is the theoretical basis of modern surgery, which is safe, fast and effective. The inter-prerenal fascia plane is the correct and safe anatomical plane of posterior laparoscopic surgery.
传统的腹腔镜手术难以处理胰腺体尾部的深部病变，可能会损伤腹腔内脏器并导致腹腔粘连等相关并发症。
本文介绍了后腹腔镜手术在胰腺手术中的操作步骤，并评估其在临床应用中的可行性。
对我院行后腹腔镜胰切除术的患者进行回顾性分析。术中观察后腹腔镜胰切除术筋膜的解剖特点、手术平面构成及手术路径，并分析手术安全性及可行性。评估以下参数：手术时间、出血量、胰瘘、术后胃肠道恢复情况、住院时间。
3例患者手术均顺利，未发生严重并发症。后腹腔镜胰切除术时，胰腺后筋膜与肾前筋膜之间存在血管化平面，可避免损伤内脏器官及腹膜后血管。应将肾前筋膜作为安全分离平面的后界。
基于筋膜解剖和间隙分离的手术平面是现代手术的理论基础，安全、快速且有效。肾前筋膜间隙平面是后腹腔镜手术正确且安全的解剖平面。
