引用文本：刘一峰, 钟小生, 喻志敏, 等. 腹腔镜胰十二指肠切除术治疗胰腺钩突恶性肿瘤的技术策略与初步疗效分析[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(3): 406-414.

作者：刘一峰，钟小生，喻志敏，沈展涛，陈桂豪，陈彦辰

单位：广东省中医院 胰腺中心，广东 广州 510120

Authors：Liu Yifeng, Zhong Xiaosheng, Yu Zhimin, Shen Zhantao, Chen Guihao, Chen Yanchen

Unit：Pancreas Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong, China

摘要：

目的 探讨以特定解剖标志为导向的腹腔镜胰十二指肠切除术（laparoscopic pancreaticoduodenectomy, LPD）中胰头全系膜切除的技术要点，并分析该策略治疗胰腺钩突恶性肿瘤的初步疗效。方法 选取2019年5月1日至2023年5月31日于广东省中医院接受LPD的33例胰腺钩突导管腺癌患者。手术以肝总动脉（common hepatic artery, CHA）、腹腔干（celiac axis, CA）和肠系膜上动脉（superior mesenteric artery, SMA）为核心解剖标志，明确胰头全系膜切除术的切除范围：上界由CHA、CA及SMA根部构成，后界为十二指肠胰腺后侧融合筋膜，左界为SMA、CA血管鞘及其附近纤维结缔组织、近端空肠系膜，下界为汇入肠系膜上静脉（superior mesenteric vein, SMV）的十二指肠空肠钩突静脉（duodenojejunal uncinate process vein, DJUV）。手术采用左后侧、正中和右后侧联合入路，重点强调完整切除胰头钩突系膜及充分清扫淋巴和神经组织。主要观察指标包括手术时间、术中出血量、R0切除率，以及胰瘘、胆瘘、淋巴漏等术后并发症发生率，同时记录患者无复发生存（recurrence-free survival, RFS）时间。结果 所有患者均顺利完成LPD。平均手术时间为（400.67±65.39） min，中位术中出血量为150.00（90.00，350.00） ml，R0切除率达到100%。术后胰瘘8例（24.24%），包括生化漏5例（15.15%）、B级瘘3例（9.09%）；术后淋巴漏2例（6.06%），无患者出现术后胆瘘。围手术期内无患者死亡。33例患者的中位随访时间为37.5个月（范围12.0~61.0个月），平均RFS时间为（15.67±11.43）个月。结论 以CHA、CA和SMA为解剖标志，采用左后侧、正中、右后侧联合入路的腹腔镜胰头全系膜切除策略，治疗胰腺钩突导管腺癌安全、可行。该手术策略可有效实现肿瘤R0切除，降低围手术期并发症风险，且具有延长患者术后RFS时间的潜力。

关键词：胰腺钩突恶性肿瘤；腹腔镜胰十二指肠切除术；胰头系膜切除

Abstract：

Objective To investigate the technical key points of total mesopancreatectomy of the pancreatic head in laparoscopic pancreaticoduodenectomy (LPD) guided by specific anatomical landmarks, and to analyze its preliminary clinical outcomes for pancreatic uncinate process carcinoma. Method Thirty-three patients with pancreatic ductal adenocarcinoma (PDAC) of the pancreatic uncinate process who underwent LPD at Guangdong Provincial Hospital of Traditional Chinese Medicine from May 1, 2019 to May 31, 2023 were selected. Taking the common hepatic artery (CHA), celiac axis (CA) and superior mesenteric artery (SMA) as the core anatomical landmarks, the resection range of total mesopancreatectomy of the pancreatic head was defined: the upper boundary was composed of the roots of CHA, CA and SMA; the posterior boundary was the posterior duodenopancreatic fusion fascia; the left boundary was the vascular sheaths of SMA and CA, the adjacent fibrous connective tissue and the proximal jejunal mesentery; the lower boundary was the duodenojejunal uncinate process vein (DJUV) draining into the superior mesenteric vein (SMV). The operation was performed via combined left posterior, median and right posterior approaches, with emphasis on complete resection of the pancreatic head uncinate mesentery and adequate clearance of lymphatic and neural tissues. The primary outcomes included operation time, intraoperative blood loss, R0 resection rate, and the incidence of postoperative complications such as pancreatic fistula, biliary fistula, and lymphatic leak. Postoperative follow-up was performed to record recurrence-free survival (RFS) time of patients. Result All patients underwent LPD successfully. The mean operation time was (400.67±65.39) minutes, the median intraoperative blood loss was 150.00 (90.00, 350.00) ml, and the R0 resection rate reached 100%. Postoperative pancreatic fistula occurred in 8 cases (24.24%), including 5 cases (15.15%) of biochemical leak and 3 cases (9.09%) of grade B fistula, while postoperative lymphatic leak was observed in 2 cases (6.06%). There were no postoperative biliary fistulas or perioperative deaths. The median postoperative follow-up time was 37.5 months (ranging from 12.0-61.0 months), and the mean RFS time was (15.67±11.43) months. Conclusion The laparoscopic total mesopancreatectomy of the pancreatic head guided by the CHA, CA and SMA using combined left posterior, median and right posterior approaches is safe and feasible for PDAC of the pancreatic uncinate process. This surgical strategy can effectively achieve R0 resection of tumors, reduce the risk of perioperative complications, and has the potential to prolong the postoperative RFS time of patients.

Key words：Pancreatic uncinate process carcinoma; Laparoscopic pancreaticoduodenectomy; Pancreatic head mesentery resection

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