腹腔镜胰十二指肠切除术kocher切口的临床解剖学研究

【摘要】 目的 探讨腹腔镜胰十二指肠切除术(LPD)中相关血管和筋膜的解剖学特点,为腹腔镜下解剖定位和操作入路提供解剖学依据。方法 本研究选取南方医科大学遗体捐献接收中心提供的5具成人新鲜尸体腹部标本,对胰十二指肠切除术的Kocher切口手术入路及相关的安全外科平面进行解剖,对相关外科平面、解剖标志及筋膜间隙进行观察分析。结果〓胰前间隙和胰后间隙及其延伸是手术的两个主要的宏观外科平面,胰腺后融合筋膜及筋膜间隙是腹腔镜下外科手术操作的天然平面,一旦偏离则会导致邻近血管和脏器的损伤。LPD手术中沿着适宜的外科平面进行游离,特别是Kocher切口手术入路的运用,能充分体现手术无损伤原则和肿瘤根治原则。供应胰十二指肠的重要血管均位于筋膜和胰腺实质之间,LPD中注意保护好胰十二肠区域相关的血管,保留筋膜的完整性即可保护后动脉弓。结论 掌握LPD相关血管和筋膜的解剖学特点可为腹腔镜手术的设计和规范提供形态学依据,从而提高腹腔镜下操作的安全性和根治的彻底性。

Clinical significance of Kocher maneuver anatomic in surgical procedure of laparoscopic pancreatoduodenectomy

Objective To explore the anatomic characteristics of the related blood vessels and fascia in laparoscopic pancreatoduodenectomy （LPD） and to provide the anatomical basis for laparoscopic anatomical location and operating approach. Methods Specimens were provided by Southern Medical University Department of anatomy. The blood vessels distribution and the fascial spaces, the communication and the relationship to adjacent were observed and described. Results The space before and behind the body of the pancreas and its extension are two major surgical planes. The fusion fascia and fascia space behinal the pancreas were the natural plane of laparoscopic surgical operation. Any deviation whould result injury of nearby blood vessels and organs. LPD along the surgical plane, especially the using of Kocher incision approach, could fully embody the operation principle of no damage and a radical cure in cancer. The important blood vessels supplying pancreas duodenum were located in the fascia and pancreas parenchyma, which should be paid more attention to protect the blood vessels near by pancreas duodenal and maintain the integrity of fascia in LPD. Conclusion Understanding of related LPD anatomy characteristics of blood vessels and fascia can provide morphologic basis for laparoscopic surgery in the design and specification of LPD, so as to improve the safety of laparoscopic operation and completeness of radical cure.