Kimura W, Muto T, Makuuchi M, Nagai H
First Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Hepatogastroenterology. 1996 Nov-Dec;43(12):1438-41.
We reported a procedure of duodenum-preserving subtotal pancreatectomy of the pancreas according to the precise anatomy of the pancreatoduodenal region, especially of the pancreaticoduodenal arteries which provide blood to the duodenum. After a complete Kocher's maneuver is performed, the pancreas is cut above the portal vein and removed from the third portion of the duodenum, followed by the removal of the posterior surface of the pancreas head from a connective tissue membrane. The main pancreatic duct is identified at its junction with the terminal portion of the bile duct from the posterior surface of the head of the pancreas and is cut at the junction. The pancreas is cut in the line of the ASPD. The reason we leave the part of the pancreas between the auodenum, ASPD and the common bile duct is that the artery toward the papilla of Vater runs along the right side of the common bile duct and would be difficult to be preserved with the removal of this part of the pancreas. The most important techniques of this procedure is to keep the connective tissue membrane of the posterior surface of the pancreas intact so as to preserve pancreaticoduodenal arteries and veins. Benign lesions as well as lowgrade malignancy of the head of the pancreas may be possible indications for this procedure.
我们报告了一种保留十二指肠的胰腺次全切除术，该手术依据胰十二指肠区域的精确解剖结构进行，尤其是为十二指肠供血的胰十二指肠动脉。在完成完整的科克伦手法后，于门静脉上方切断胰腺，并将其从十二指肠第三段移除，接着从结缔组织膜上移除胰头后表面。在胰头后表面确定主胰管与胆管终末部的连接处，并在此处切断主胰管。沿胰腺钩突部的连线切断胰腺。我们保留十二指肠、胰腺钩突部与胆总管之间部分胰腺的原因是，朝向 Vater 乳头的动脉沿胆总管右侧走行，切除这部分胰腺时难以保留该动脉。此手术最重要的技术是保持胰腺后表面的结缔组织膜完整，以保留胰十二指肠动静脉。胰腺头部的良性病变以及低度恶性肿瘤可能是该手术的适应证。
