腹腔镜前入路静脉优先与右后入路动脉优先联合切除钩突的优势

随着腹腔镜胰腺手术技术水平的快速提高,腹腔镜胰十二指肠切除术在国内部分胰腺中心已逐渐开展。钩突切除是腹腔镜胰十二指肠切除术的关键步骤之一,影响着手术时间、术中出血量、肿瘤的R0切除等,如何较好处理钩突切除仍是腹腔镜胰十二指肠切除术的难点之一。目前,腹腔镜胰十二指肠切除术钩突切除的方法众多,各有利弊。笔者结合自身经验,总结了在腹腔镜胰十二指肠切除术中采用前入路静脉优先联合右后入路动脉优先的方法切除钩突,可大大缩短手术时间,减少术中出血量,提高肿瘤的R0切除率。在临床实践中该入路优势明显,安全可行。

The advantages of anterior "vein-first" combined with right posterior "artery-first" approach in laparoscopic pancreaticoduodenectomy

With the rapid development of laparoscopic pancreatic surgery, laparoscopic pancreaticoduodenectomy have been performed gradually in some pancreatic centers in China. Resection of uncinate process is a key step of laparoscopic pancreaticoduodenectomy which greatly affects duration of operation, blood loss and R0 resection rate. One of challenges in laparoscopic pancreaticoduodenectomy is uncinate process resection. However, recent methods of uncinate process resection in laparoscopic pancreaticoduodenectomy have both advantages and disadvantages. Based on our own experience, the author summarizes a new method of uncinate process resection by using anterior "vein-first" combined with right posterior "artery-first" approach in laparoscopic pancreaticoduodenectomy. This approach could shorten the operation time, reduce blood loss and could increase R0 resection rate, with obvious superiority and safety in laparoscopic pancreaticoduodenectomy in clinical setting.