CAJ | 학술논문

作者在为胰头癌施行根治性胰十二指肠切除术的过程中,依据实践,结合文献复习,针对目前的某些热点问题,提出应避免主动性姑息性胰十二指肠切除术.提倡淋巴结廓清至少应达二站淋巴结,建议将肝十二指肠韧带骨骼化清扫和腹膜后组织切除作为根治性胰十二指肠切除术的常规手术步骤,无论有无证据支持第13组淋巴结(胰头后淋巴结)已发生转移,均应对可切除胰头癌进行限制性腹膜后组织切除.显露肠系膜上动脉并辨清钩突下缘和左侧缘与动脉的关系,是保证钩突切除完整性的技术要点.术前评估血管成像等影像学资料,可提高主动性联合血管切除的手术比例.胰肠吻合方式的选择,手术者的经验非常重要,从自己熟悉和熟练的二三种方法中选择最适合患者的方式,作者更偏向于胰肠端侧双层套入吻合法.并认为能量外科技术平台(电外科工作站)应用应慎重,仍须积累更多的经验再做评价.
작자재위이두암시행근치성이십이지장절제술적과정중,의거실천,결합문헌복습,침대목전적모사열점문제,제출응피면주동성고식성이십이지장절제술.제창림파결곽청지소응체이참림파결,건의장간십이지장인대골격화청소화복막후조직절제작위근치성이십이지장절제술적상규수술보취,무론유무증거지지제13조림파결(이두후림파결)이발생전이,균응대가절제이두암진행한제성복막후조직절제.현로장계막상동맥병변청구돌하연화좌측연여동맥적관계,시보증구돌절제완정성적기술요점.술전평고혈관성상등영상학자료,가제고주동성연합혈관절제적수술비례.이장문합방식적선택,수술자적경험비상중요,종자기숙실화숙련적이삼충방법중선택최괄합환자적방식,작자경편향우이장단측쌍층투입문합법.병인위능량외과기술평태(전외과공작참)응용응신중,잉수적루경다적경험재주평개.
According our practice of raical pancreaticoduodenectomy for pancretic head carcinoma and combined with these reviews, we suggested the active and palliative pancreaticoduodenectomy should be aviod. Skeletonization of hepatoduodenal ligament and the retroperitoneal resection should be the routine procedure in pancreticoduodenectomy, and at least invovle two regional lymph nodes. In addition, regardless of the metastase of No 13 lymph node, ristricted retroperitoneal resection for resectable pancretic carcinoma was needed. Exposured the superior mesenteric artery and distinguished inferior of uncinate process of pancrease with the artery, were the key point of the uncinate process of pancrease resection. Preoperative evaluation of angiography and other images, the ratio of activeness and combination with vessel resection would be improved. The style of pancreaticojejunostomy could be selected by the experience of the operator, we are apt to the double-deck invaginated pancreaticojejunostomy. Additionally, utilization of the electronic surgical workstation, should be careful and also need to accumulate more experience.