摘要
目的探讨腹腔镜胰十二指肠切除术(laparoscopic pancreatoduodenectomy,LPD)中利用带蒂肝圆韧带包裹胃十二指肠动脉(gastroduodenal artery,GDA)残端预防术后出血的安全性和可行性。方法在常规完成LPD后,从壁腹膜上游离肝圆韧带,超声刀或Ligasure将肝圆韧带与镰状韧带分离,其中小血管可用超声刀或Ligasure凝闭,一直游离至肝圆韧带与肝脏连接处,不行离断,保留带蒂的肝圆韧带,以保证血供。GDA用合成夹双重夹闭或4-0血管线缝扎。带蒂的肝圆韧带可完全包裹骨骼化的GDA残端,同时包裹部分肝总动脉及肝固有动脉,一般选择4-0血管滑线连续缝合(操作见视频1)。包裹完成后于其上放置腹腔引流管。选取2018年3月-2019年3月在我中心完成LPD后行带蒂肝圆韧带包裹GDA残端的108例患者临床资料进行分析。结果108例患者完成LPD术中采用带蒂肝圆韧带包裹GDA残端,术后无因肝圆韧带包裹GDA残端导致的并发症发生,包裹GDA残端的主要步骤完成时间平均为10 min,术后共有8例(7.4%)患者发生临床相关胰瘘(包括B级胰瘘6例和C级胰瘘2例),8例(7.4%)患者出现腹腔感染,包括3例(2.8%)患者腹腔脓肿,2例(1.9%)患者出现术后胃肠道内溃疡出血,无腹腔内出血发生。结论LPD术中利用带蒂肝圆韧带包裹GDA残端预防LPD术后出血是一项安全可行的技术。该方法游离的带蒂肝圆韧带包裹GDA残端后没有张力。该步骤简单易行,不增加额外的手术创伤及延长手术时间。
Objective To explore the feasibility and safety of teres hepatis ligament flap plasty around the gastroduodenal artery(GDA)stump to prevent postoperative hemorrhage after laparoscopic pancreatoduodenectomy(LPD).Methods A total of 108 patients with GDA stump wrapped by pedicled teres hepatis ligament after LPD in our center were included for analysis from March 2018 to March 2019.After completion of LPD,teres hepatis ligament was dissected from the ventral abdominal cephalad along the ventral attachment,and the teres hepatis ligament was separated from the falciform ligament by ultrasonic scalpel or Ligasure.At the junction to the liver,the teres hepatis ligament is freed from the ventral hepatic surface.The junction between liver and teres hepatis ligament should not be cut off to ensure blood supply.Division of the GDA was performed using a Prolene 4-0 suture stitch or two clamps as a standard(see the Video 1 in Supplemental Contents,http://ykxb.scu.edu.cn/article/doi/10.12182/20200760602).The pedicled teres hepatis ligament then was used to completely cover the skeletonized GDA stump,and part of the common hepatic artery and the proper hepatic artery.The mobilized ligament can be transposed without tension.Results A total of 108 patients completed the procedure of GDA stump wrapped with pedicled teres hepatis ligament during LPD.There were no complications caused by GDA stump after operation.The main steps to wrap the GDA stump took an average of 10 min.Clinically relevant postoperative pancreatic fistula(CR-POPF)occurred in 8 cases(7.4%)(including 6 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula),and intra-abdominal infection in 8 cases(7.4%),including 3 cases(2.8%)of intra-abdominal abscess,postoperative gastrointestinal ulcer bleeding occurred in 2 cases(1.9%),and no intra-abdominal hemorrhage occurred.Conclusion It is a safe and feasible procedure of wrapping GDA stump with pedicled teres hepatis ligament to prevent postoperative hemorrhage after LPD.The procedure is easy to p
作者
孟令威
高攀
彭兵
MENG Ling-wei;GAO Pan;PENG Bing(Department of Hepatobiliary Pancreas Minimally Invasive Surgery,Shangjin Hospital of West China Hospital,Sichuan University,Chengdu 611730,China;Department of Pancreatic Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2020年第4期453-456,共4页
Journal of Sichuan University(Medical Sciences)
基金
国家卫生计生委医药卫生科技发展研究中心重大项目(No.W2017ZWS07)
四川省科技厅科技支撑计划项目(No.2017SZ0126)
四川大学华西医院学科卓越发展1·3·5工程临床研究孵化项目(No.2018HXFH015)资助。
关键词
肝圆韧带
腹腔镜胰十二指肠切除术
术后出血
胃十二指肠动脉残端
Teres hepatis ligament
Laparoscopic pancreatoduodenectomy
Postoperative hemorrhage
Gastroduodenal artery stump
