First jejunal vein oriented mesenteric excision for pancreatoduodenectomy

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• 作者：Masafumi Nakamura (1)
  Hiroshi Nakashima (1)
  Kosuke Tsutsumi (1)
  Hideo Matsumoto (1)
  Yu Muta (1)
  Daisuke Ueno (1)
  Koji Yoshida (2)
  Keisuke Hino (2)
  Atsushi Urakami (1)
  Masao Tanaka (3)
  
• 关键词：First jejunal vein ; pancreaticoduodenectomy ; Mesenteric excision
• 刊名：Journal of Gastroenterology
• 出版年：2013
• 出版时间：August 2013
• 年：2013
• 卷：48
• 期：8
• 页码：989-995
• 全文大小：360KB
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• 作者单位：Masafumi Nakamura (1)
  Hiroshi Nakashima (1)
  Kosuke Tsutsumi (1)
  Hideo Matsumoto (1)
  Yu Muta (1)
  Daisuke Ueno (1)
  Koji Yoshida (2)
  Keisuke Hino (2)
  Atsushi Urakami (1)
  Masao Tanaka (3)
  
  1. Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
  2. Division of Hepatology and Pancreatology, Kawasaki Medical College, Kurashiki, Japan
  3. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  

文摘

Background Dissection of the pancreatic head from the superior mesenteric vein (SMV) and artery (SMA) are major points of bleeding in pancreaticoduodenectomy (PD) because of congestion of the pancreatic head. The “SMA-first-approach, which involves ligating the artery from the SMA first, can be used to solve this problem. However, the SMA-first approach has problematic anatomical issues. We applied a new surgical approach, first jejunal vein oriented mesenteric excision (FME), for PD. This study aimed to clarify the effect of FME on reduction of bleeding during PD. Methods The jejunal vein, the most frequent source of bleeding during dissection of the mesoduodenum, was identified at the beginning of dissection of the pancreatic head from SMV and SMA. The mesoduodenum, including plural IPDAs, was completely divided before dissection of the pancreatic head from the SMV. The perioperative outcomes of two groups, patients who underwent FME-based PD and patients who underwent standard PD, were compared. Additionally, the spatial characteristics of the first jejunal vein (FJV) were analyzed using computed tomography. Results FME-based PD significantly reduced intraoperative blood loss compared with conventional PD (569 vs. 1094?ml, P?=?0.0315). The median distance of the FJV was 0?mm from the middle colic artery and 0?mm from the third portion of the duodenum. The FJV was posterior to the SMA in the majority of the patients but was anterior to the SMA in 16.7?% of patients. Conclusions FME is useful for reducing intraoperative bleeding.