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腹腔镜保留胰腺的十二指肠切除术:针对非壶腹浅表性十二指肠上皮肿瘤的微创外科手术。

Laparoscopic pancreas-preserving duodenectomy: Minimally invasive surgery for superficial nonampullary duodenal epithelial tumors.

机构信息

Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.

Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.

出版信息

Asian J Endosc Surg. 2024 Jan;17(1):e13247. doi: 10.1111/ases.13247. Epub 2023 Oct 3.

Abstract

No consensus exists regarding the optimal treatment for superficial nonampullary duodenal epithelial tumors. Herein, we describe a laparoscopic pancreas-preserving duodenectomy for the treatment of a 30-mm adenoma located in the third portion of the duodenum. The adenoma was located on the pancreatic side, further hindering safe endoscopic resection. Via laparoscopy, the jejunum was transected first. After releasing the third portion of the duodenum from the retroperitoneal space, the jejunum was pulled to the right side of the superior mesenteric artery and separated from the pancreas. Under endoscopic guidance, the duodenum was then transected and duodenojejunostomy performed intracorporeally. Laparoscopic pancreas-preserving duodenectomy can be considered minimally invasive, achieving tumor radicality while preserving organs and causing minimal destruction to the abdominal wall. In conclusion, although technically demanding, laparoscopic pancreas-preserving duodenectomy is a valuable treatment option for superficial nonampullary duodenal epithelial tumors.

摘要

对于浅表非壶腹十二指肠上皮性肿瘤的最佳治疗方法,目前尚无共识。在此,我们介绍了一例腹腔镜保留胰头十二指肠切除术治疗位于十二指肠第三部分的 30mm 腺瘤。该腺瘤位于胰腺侧,进一步妨碍了安全的内镜下切除。通过腹腔镜,首先横断空肠。将十二指肠从腹膜后间隙释放后,将空肠向右牵拉至肠系膜上动脉的右侧,并与胰腺分离。在内镜引导下,然后横断十二指肠并进行腔内肠-肠吻合术。腹腔镜保留胰头十二指肠切除术可被认为是微创的,既能达到肿瘤根治性,又能保留器官,对腹壁的破坏最小。总之,尽管技术要求较高,但腹腔镜保留胰头十二指肠切除术是治疗浅表非壶腹十二指肠上皮性肿瘤的一种有价值的治疗选择。

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