Objective:To investigate the value of total arteries devascularization first technique in radical pancreaticoduodenectomy.
Methods:The clinical data of 58 patients with malignant pancreatic head cancer who received pancreaticoduodenectomy at the Tongji Hospital from January 2012 to May 2013 were retrospectively analyzed. The results of preoperative thin-slice computed tomography scanning indicated that the portal vein and superior mesenteric vein were invaded by the tumor. During the operation, 3 arterial blood supplies of the head of the pancreas were obstructed before devascularization of vein in the head of pancreas. The key steps of the technique were: (1) The superior mesenteric artery and vein were dissected at lower parts of the duodenal mesenterium. (2) The common hepatic arteries were dissected to cut the right gastric artery and the gastroduodenal artery. (3) Dissecting the celiac trunk and transecting the branches of splenic artery in the head of the pancreas. (4) Neural and connective tissues between the superior mesenteric artery and the uncinate process of the pancreas were dissected, and then the anterior surface of the abdominal aorta was excellently exposed. (5) The superior mesenteric vein or portal vein were dissected or rebuilt with the help of presetting vascular blocking bands, and then the tumor was en-bloc resected.
Results:The operation time was 4.5-900 mL. No bleeding of the uncinate process of the pancreas was detected. Twenty-one patients underwent lateral vessel angiectomy or angiorrhaphy, 10 received resection of the superior mesenteric vein which was invaded by the tumor and end-to-end anastomosis, and 27 received detachment of tumor from the blood vessel and pancreatoduodenectomy. The incidences of hemorrhage, pancreatic fistula and biliary fistula were 6.9%(4/58) and 1.7%(1/58). No patient died perioperatively.
Conclusion:Total arteries devascularization first technique could improve the safety and reduce intraoperative bleeding in radical pancreaticoduodenectomy.
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