The Study Of Anotomy And Clinic Application Of Laparoscopic Pancreaticoduodenectomy Via Uncinate Process Approach

Objective:To research the anatomic characteristics of the superior mesenteric vascular associated with laparoscopic pancreaticoduodenectomy and its clinical significance to laparoscopic pancreaticoduodenectomy via uncinate process approach.To explore the safety and feasibility of laparoscopic pancreaticoduodenectomy via uncinate process approach. Methods:1. 4 adult cadaver specimens were dissected to observe the superior mesenteric vascular arrouding the pancreaneun.2. 96 cases of adults patient’s upper abdomen underwent 64 multislice spiral computed tomography angiography,and 3D reconstructed by Volume Rendering(VR) and Maximum Intensity Projection(MIP).3.13 cases of laparoscopic pancreaticoduodenectomy via uncinate process approach performed from February 2010 to July 2015 All the clinical observation indexes were analyzed. Results:1.Taking the back view,the portal superior mesenteric vein could be described as three sections :(1) superior pancreas section,(2) pancreas section,(3) duodenal section. the duodenal section of superior mesenteric vein was closely related to the superior mesenteric artery.2. 64 slice spiral CT blood vessel reconstruction has a good display rate to the main vessels of the pancreas, and the display rate of the artery is higher than that of the vein.3. 13 cases of laparoscopic pancreaticoduodenectomy via uncinate process approach were performed at all. The surgical time ranged from 240 to 340 minutes(mean: 280±38 min), the intraoperative blood loss ranged from 150 to 1200 m L(mean: 300±45 m L), and the number of dissected lymph nodes ranged from 9 to 15(mean: 10). Reoperation rate was 15.4%(2/13), incidence of postoperative complications was 27.3%(3/11).Postoperative pathology revealed negative margins in the specimens. Postoperative local recurrence rate was 7.7%(1/13), and the blood metastasis(liver) rate was 23.1%(3/13). The 1 year survival rate was 84.6%(11/12), the 2 year survival rate was 71.4%(5/7), and the 3 year survival rate was 60%(3/5). Conclusion:1.the anatomic characteristics of the superior mesenteric vascular associated with laparoscopic pancreaticoduodenectomy would be determined by MSCTA, And it could be possible to provide a theoretical basis for the laparoscopic pancreaticoduodenectomy via uncinate process approach.2. Taking the back view,the portal superior mesenteric vein could be described as three sections :(1) superior pancreas section,(2) pancreas section;(3) duodenal section,T Taking the back view,the portal superior mesenteric vein could be described as three sections:(1) superior pancreas section,(2) pancreas section,(3) duodenal section. the duodenal section of superior mesenteric vein are the important anatomic marks for laparoscopic surgery. It is important clinical significance to the laparoscopic pancreaticoduodenectomy via uncinate process approach.3. Laparoscopic pancreaticoduodenectomy via uncinate process approach is appropriate for dessecting the mensopancreas,and the R0 resection rate would be improved. The standard pancreaticoduodenectomy with lymph node dissection coule be completed with laparoscopic surgery.4. The laparoscopic pancreaticoduodenectomy via uncinate process approach is a safe and feasible suegery,it is a kind of reasonable surgical procedure for laparoscopic pancreaticoduodenectomy, and is worthy of further reseach.