动脉优先入路联合三静脉悬吊在胰头癌根治术中的应用

目的 探讨动脉优先入路联合三静脉悬吊在胰头癌根治术中的应用价值。方法 回顾性分析2018年1月至2022年1月在泰州人民医院采用动脉优先入路联合三静脉悬吊技术，施行胰十二指肠切除术的36例胰头癌患者临床资料。术前采用磁共振成像（MRI）、多层螺旋CT血管成像（CTA）判断病灶的性质、部位、大小及其与周围血管的毗邻关系，术中采用动脉优先入路联合三静脉悬吊技术，彻底清扫肠系膜上动脉和腹腔干为轴的右侧神经淋巴组织，必要时联合静脉切除重建。及时处理患者围手术期并发症。结果 所有患者均顺利完成手术，无围手术期死亡病例。手术时间（310±36）min，术中出血量（155±80）mL。术后病理示所有标本切缘均阴性，清扫淋巴结（15±7）枚，淋巴结阳性率52.8%。术后并发症发生10例（27.8%），其中A级胰瘘5例，B级胰瘘2例，胃瘫2例，均经保守治疗治愈；胰腺残端出血1例，经开腹手术止血治愈。所有患者均获随访，术后生存时间为5～48个月，中位生存时间为26.8个月。结论 胰十二指肠切除术中采用动脉优先入路联合三静脉悬吊的方法，可以使肠系膜上动脉和腹腔干为轴的右侧神经淋巴组织完整切除，便于联合静脉切...

Application of arterial first approach combined with three veins suspension in radical resection of carcinoma of pancreatic head

Objective To evaluate the value of artery first approach combined with three veins suspension in radical resection of carcinoma of pancreatic head. Methods The clinical data of 36 patients, who underwent pancreaticoduodenectomy between Jan. 2018 and Jan. 2022 in Taizhou People’s Hospital, was retrospectively analyzed. Preoperative magnetic resonance imaging (MRI) or multislice spiral computed tomography angiography (CTA) was used to determine the nature, location and size of the lesion, and its relationship with the surrounding blood vessels. The arterial first approach combined with triple veins suspension were used to thoroughly dissect the right neurolymphatic tissue, with the superior mesenteric artery and abdominal trunk as axes. If necessary, combined vein resection and reconstruction was adopted. The perioperative complications were managed timely. Results All 36 patients were successfully completed pancreaticoduodenectomy through arterial first approach combined with three veins suspension, and there was no perioperative death. The operation time was (310±36) min, and the amount of blood loss was (155±80) mL. All resection margins were negative, (15±7) lymph nodes were cleaned, and the positive rate of lymph nodes was 52.8%. Postoperative complications occurred in 10 cases (27.8%), including 7 pancreatic fistula cases (5 with grade A, 2 with grade B), 2 gastroparesis cases, all 9 cases were cured by conservative treatment; the other 1 case with pancreatic stump bleeding, was cured by laparotomy. All patients were followed-up, the postoperative survival time was 5~48 months, and the median survival time was 26.8 months. Conclusion In pancreaticoduodenectomy, the method of arterial priority approach combined with three veins suspension can completely resect the right nerve lymphatic tissue, with the superior mesenteric artery and coeliac trunk as axes, which facilitate the combined vein resection and reconstruction, to ensure the radical resection of tumor. This method is safe and feasible with less intraoperative bleeding and less postoperative complications.