Hanoi Medical University, Hanoi, Vietnam.
Center of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam.
World J Surg Oncol. 2024 May 28;22(1):141. doi: 10.1186/s12957-024-03416-3.
SMA-first approach in pancreatoduodenectomy (PD) has been widely applied in open surgery as well as laparoscopy. Finding the superior mesenteric artery (SMA), inferior pancreatoduodenal artery (IPDA), first jejunal artery (J1A) has become a great challenge in laparoscopic PD (LPD). Meanwhile, exposing the midde colic artery (MCA) might be a feasible approach to determine SMA, IPDA, and J1A. Our study aims to find the anatomical correlation between MCA and SMA, IPDA, J1A, especially in SMA-first approach LPD from the left.
Uncontrolled clinical trial with 33 patients undergoing LPD had preoperative contrast abdominal CT scan to analyze the anatomical relevance between MCA and SMA, J1A, IPDA. The operation was performed starting with exposing MCA in advance to find SMA, J1A and IPDA. The data was analyzed by SPSS 25.0.
90.9% of MCA started at 12-3 o'clock from SMA, the mean distance from the SMA root to the MCA and J1A was 56.4 mm and 37.4 mm, respectively. The distance between SMA and J1A was 19 mm. 72.7% J1A started at 9-12 o'clock, 69.7% J1A and IPDA had a common trunk. 78.8% IPDA started at 3-6 o'clock. 100% of the cases had J1A controlled intraoperatively, 81.8% for IPDA when approached from the left, 3% had MCA injury. The mean time to approach from the left was 98 min, median blood loss was 100 ml.
Exposing MCA first helps determine SMA, J1A and IPDA safely, efficiently and faciliates SMA-first approach LPD from the left and complete dissection of the mesopancreas and lymph nodes.
在开腹手术和腹腔镜手术中，SMA-first 方法已广泛应用于胰十二指肠切除术（PD）。在腹腔镜 PD（LPD）中，找到肠系膜上动脉（SMA）、下胰十二指肠动脉（IPDA）和第一空肠动脉（J1A）已成为一项巨大挑战。同时，暴露中间结肠动脉（MCA）可能是确定 SMA、IPDA 和 J1A 的可行方法。我们的研究旨在从左侧 SMA-first 方法 LPD 的角度，找到 MCA 与 SMA、IPDA 和 J1A 之间的解剖相关性。
对 33 例行 LPD 的患者进行了术前对比腹部 CT 扫描，以分析 MCA 与 SMA、J1A 和 IPDA 之间的解剖相关性。手术从预先暴露 MCA 开始，以找到 SMA、J1A 和 IPDA。数据采用 SPSS 25.0 进行分析。
90.9%的 MCA 起始于 SMA 的 12-3 点钟位置，SMA 根部到 MCA 和 J1A 的平均距离分别为 56.4mm 和 37.4mm。SMA 和 J1A 之间的距离为 19mm。72.7%的 J1A 起始于 9-12 点钟位置，69.7%的 J1A 和 IPDA 有共同的干。78.8%的 IPDA 起始于 3-6 点钟位置。100%的病例在手术中可控制 J1A，81.8%的病例从左侧接近时可控制 IPDA，3%的病例出现 MCA 损伤。从左侧接近的平均时间为 98 分钟，中位数出血量为 100ml。
首先暴露 MCA 有助于安全、高效地确定 SMA、J1A 和 IPDA，并促进左侧 SMA-first 方法 LPD 和肠系膜和淋巴结的完整解剖。
