CAJ | 학술논문

目的介绍“钩突优先切除”在根治性钩突完整切除术中的应用.方法 2010年12月至2011年6月共有23例患者采用了“钩突优先”的方法,其中进行了 20例胰头十二指肠切除术及保留幽门的胰头十二指肠切除术,3例全胰十二指肠切除术(其中2例保留了脾动静脉和脾脏).对23例患者临床资料、病理检查结果和术中术后的情况进行回顾性分析,介绍临床应用钩突优先切除的初步体会.结果此方法成功应用于23例患者,其中胰头癌中合并门静脉的整块切除1例,门静脉的阻断时间为16 min.术中发现3例患者存在异位或副肝右动脉,发生率为21％,1例患者肝总动脉起源于肠系膜上动脉,均得到确认和保存.3例行全胰十二指肠切除术,胰腺完整切除,其中2例保存了脾动静脉和脾脏.无术中大出血或误伤等其他并发症发生,平均失血约600 ml.术后无顽固性腹泻的发生.包括胰腺腹膜后切缘在内的所有外科切缘均阴性.结论 “钩突优先切除”是一项有效、安全的胰腺外科创新技术,可作为现代胰腺外科技术的补充.该项技术的优势在全胰切除术中尤为明显.与标准胰腺切除比较,其对预后的影响仍有待多中心的临床研究.
목적 개소“구돌우선절제”재근치성구돌완정절제술중적응용.방법 2010년12월지2011년6월공유23례환자채용료“구돌우선”적방법,기중진행료 20례이두십이지장절제술급보류유문적이두십이지장절제술,3례전이십이지장절제술(기중2례보류료비동정맥화비장).대23례환자림상자료、병리검사결과화술중술후적정황진행회고성분석,개소림상응용구돌우선절제적초보체회.결과 차방법성공응용우23례환자,기중이두암중합병문정맥적정괴절제1례,문정맥적조단시간위16 min.술중발현3례환자존재이위혹부간우동맥,발생솔위21％,1례환자간총동맥기원우장계막상동맥,균득도학인화보존.3례행전이십이지장절제술,이선완정절제,기중2례보존료비동정맥화비장.무술중대출혈혹오상등기타병발증발생,평균실혈약600 ml.술후무완고성복사적발생.포괄이선복막후절연재내적소유외과절연균음성.결론 “구돌우선절제”시일항유효、안전적이선외과창신기술,가작위현대이선외과기술적보충.해항기술적우세재전이절제술중우위명현.여표준이선절제비교,기대예후적영향잉유대다중심적림상연구.
Objective To describe a novel technical modification of the uncinate process first approach with a retrograde dissection of the pancreatic head.Methods The authors described the surgical technique,and reported their preliminary experience.The surgical data,postoperative outcomes and pathological results of patients who were submitted to PD/PP PD (20 patients) and TP (3 patients) for pancreatic neoplasm using “the uncinate process first” technique between December 2010and May 2011 were reviewed.Retrograde resection of the pancreatic head was performed starting with the uncinate process after division of the first jejunal loop.The transection of the pancreas was the last operative step of the resection.The technical aspects and possible advantages of this procedure were discussed.Results The authors used this technique successfully in 23 patients.In 3 patients with a replaced or accessory RHA,the arteries were all successfully preserved.In another patient with a replaced HCA,the artery was also successfully preserved.In 1 patient with adenocarcinoma which involved the SMV,en-bloc vascular resection was carried out.Additionally,the authors used this technique on 3 patients with IPMN-2 and SPPN-1 to carry out total pancreatectomy.The uncinate process first was performed on 23 patients without any intraoperative and postoperative complication and massive bleeding.No patient required blood transfusion.The surgical margins,including retroperitoneal marginswere negative.Conclusions The “uncinate process first” approach can be used as an alternative approach in modern pancreatic surgery.Further studies are required to evaluate this procedure regarding operative parameters and postoperative outcomes when compared with the standard resectional procedure.