【摘要】：目的:探討腹腔鏡胰十二指腸切除術(shù)相關(guān)腸系膜上血管的解剖學(xué)特點(diǎn)及其臨床意義,以及鉤突入路腹腔鏡胰十二指腸切除術(shù)的安全性與可行性。方法:對(duì)4具尸體解剖學(xué)觀察和96例上腹部MSCTA的血管重建,分析腸系膜上血管的分布與走行;實(shí)施鉤突入路腹腔鏡胰十二指腸切除術(shù),并對(duì)所有病例的各項(xiàng)臨床觀察指標(biāo)進(jìn)行分析。結(jié)果:1.背側(cè)觀的門-腸系膜上靜脈可分為三段:胰腺上段、胰腺段和十二指腸段;.其中腸系膜上靜脈十二指腸段與腸系膜上動(dòng)脈的關(guān)系密切。2.MSCTA對(duì)胰周主要血管的顯示率100%,胰周小動(dòng)靜脈的顯示率58.3%-85.4%。3.共實(shí)施13例鉤突入路腹腔鏡胰十二指腸切除術(shù),平均手術(shù)時(shí)間:280±38 min,術(shù)中出血:300±45mL,中轉(zhuǎn)開腹率15.4%。清除淋巴結(jié)9~15枚,R0切除率100%。術(shù)后并發(fā)癥27.3%,再次手術(shù)率15.4%。術(shù)后局部復(fù)發(fā)率7.7%,血行(肝)轉(zhuǎn)移率23.1%。術(shù)后1年生存率84.6%,術(shù)后2年生存率71.4%,術(shù)后3年生存率60%。結(jié)論:1.通過尸體解剖與MSCTA研究,發(fā)現(xiàn)MSCTA可以提供準(zhǔn)確的胰十二指腸切除術(shù)相關(guān)腸系膜上血管的分布與走行,為鉤突入路腹腔鏡胰十二指腸切除術(shù)提供理論基礎(chǔ)。2.從背側(cè)觀,可將門靜脈-腸系膜上靜脈分為胰腺上段、胰腺段和十二指腸段等三段,腸系膜上靜脈是腔鏡下顯露腸系膜上動(dòng)脈的重要解剖標(biāo)志,對(duì)實(shí)施鉤突入路腹腔鏡胰十二指腸切除術(shù)有重要的臨床指導(dǎo)意義。3.鉤突入路腹腔鏡胰十二指腸切除術(shù)可以完成胰腺系膜全切除,提高R0切除率,完成標(biāo)準(zhǔn)胰十二指腸切除術(shù)的淋巴結(jié)清掃。4.鉤突入路腹腔鏡胰十二指腸切除術(shù)具有較好的安全性與可行性,是一種較合理的腹腔鏡胰十二指腸切除術(shù)的手術(shù)方式,值得進(jìn)一步研究。
文內(nèi)圖片：
圖片說明：尸體解剖：胰十二指腸下動(dòng)、靜脈；腸系膜上靜脈、胰腺鉤突
[Abstract]:Objective: to investigate the anatomical characteristics and clinical significance of superior mesenteric vessels associated with laparoscopic pancreaticoduodenectomy, and the safety and feasibility of laparoscopic pancreaticoduodenectomy via uncinate process approach. Methods: the distribution and course of superior mesenteric vessels were analyzed by anatomical observation in 4 cadavers and vascular reconstruction in 96 cases of upper abdominal MSCTA, laparoscopic Pancreatoduodenectomy by hook approach was performed, and the clinical observation indexes of all cases were analyzed. Result: 1. The dorsolateral portal-superior mesenteric vein can be divided into three segments: the upper segment of the pancreas, the segment of the pancreas and the segment of the duodenum. There was a close relationship between the duodenal segment of the superior mesenteric vein and the superior mesenteric artery. 2.The display rate of MSCTA for the main peripancreatic vessels was 100%, and the display rate of peripancreatic arteriovenous was 58.3% 鈮，

本文編號(hào)：2512108