摘要
目的:探讨腹腔镜胰十二指肠切除术(laparoscopic pancreatoduodenectomy,LPD)中相关血管及筋膜的解剖学特点,为腹腔镜下解剖定位、操作入路提供解剖学依据。方法:通过对甲醛固定的标本原位与离体观察,同时选取第四军医大学西京医院肝胆外科杨雁灵副教授1例完全LPD手术视频,对血管分布、系膜间隙位置、沟通及毗邻关系进行观察与描述。结果:胰前间隙、胰后间隙及其延伸是手术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,一旦偏离可导致邻近血管、脏器损伤。LPD术中沿适宜的外科平面进行游离,尤其Kocher切口手术入路的应用,充分体现了手术无损伤原则及肿瘤根治原则。供应胰十二指肠的重要血管均位于筋膜与胰腺实质间,LPD术中注意保护好胰十二指肠区域相关的血管,保留筋膜的完整性即可保护后动脉弓。探查及显露肠系膜上静脉以胃网膜右静脉作为术中标志,可更好地显露肠系膜上静脉,减少对周边组织的损伤及并发症的发生,提高了手术效率。结论:掌握LPD相关血管及筋膜的解剖学特点可为腹腔镜手术的设计与规范提供形态学依据,从而提高腹腔镜下操作的安全性及根治的彻底性。
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：By observation of specimens in situ and in vitro. 1 cases of LPD surgery videos done by professor YANG Yah-ling from department of liver and gallbladder surgery, Xijing hospital ,fourth military medical university were analyzed. The blood vessels distribution and the position of mesangial clearance, the communication and the relationship to adjacent were observed and described. Results：The clearance before and after pancreas and its extension are two of the major macro surgical planes, the fusion fascia after pancreas and fascia space are the natural plane of laparoscopic surgical operation. Any deviation will result in nearby blood vessels and organs injury. LPD along the suit- able surgical plane for free in the operation, especially the using of Kocber incision surgical approach, can fully embody the operation principle of no damage and a radical cure in cancer. The important blood vessels supplying pancreas and duodenum located in the fascia and pancreas parenchyma, which should be paid more attention to protect the pancreatic and duodenum area related blood vessels and maintain the integrity of fascia in LPD to protect posterior arterial arcades. Detection and reveal the superior mesenteric vein with right stomach retinal vein as an intraoperative marker, can better reveal the superior mesenteric vein, reduce the damage to surrounding tis- sues and complications, and improve the operation efficiency. Conclusions：To grasp anatomy characteristics of LPD related 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.
出处
《腹腔镜外科杂志》
2014年第5期351-355,共5页
Journal of Laparoscopic Surgery
