Name: laparoscopic radical antegrade modular pancreatosplenectomy via dorsal-caudal artery approach for pancreatic neck-body cancer
Uploaded: 2022-11-18T12:30:00
Description: Watch this Scientific Journal Video about Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer at JoVE.com

本协议遵循广州中医药大学附属第二医院伦理规范。本文和视频已获得患者的知情同意。
1. 患者选择
<ol><li>确保患者在胰腺颈部、身体和尾部有 PDAC，并通过增强计算机体层成像 （CT） 确诊。该程序适用于以下情况：新辅助治疗后的可切除胰腺癌和临界可切除胰腺癌。当肿瘤在有效的新辅助治疗后明显消退时，根治性切除的可能性增加。 注意：在所呈现的病...

<ol>
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尽管PDAC的生存率为5年，但对于有机会进行根治性切除术的患者来说，这仍然不令人满意;到目前为止，手术一直是唯一的治疗方法22.可切除性状态主要通过区域关键血管的状况来评估，包括 SMA、CeA、CHA 和 SMV24，25。虽然术前 X 线检查可以提供有关血管疾病的充分信息，但对于评估不明确的患者，尤其是对于既往接受过新辅助化疗的患?...

根治性顺行模块化胰腺脾切除术（RAMPS）是一种针对位于胰体或胰尾的恶性肿瘤的精细手术，由Strasberg于2003年首次描述。该手术策略基于胰腺的血液和淋巴结引流而设计，以实现无肿瘤解剖平面和区域淋巴结根治性切除1。RAMPS越来越受到外科医生的重视，因为它可能有利于获得无肿瘤边缘和相对有利的生存结果2，3，4。随着微创手术器械和技术的进步，腹腔镜斜坡（L-RAMPS）因其几个优点而逐渐普及，包括术中失血少、输血需求减少以及疼痛和感染等切口事件减少1。对于精心挑选的远端胰腺导管腺癌（PDAC）患者，最近的研究表明，L-RAMPS可能是一种有效且安全的方法1，5，6。
在胰头区域恶性肿瘤的胰十二指肠切除术 （PD） 中，动脉优先方法是一种被广泛接受的策略，具有多个优点。该方法的核心原理是在手术早期探索肠系膜上动脉（SMA），以确定胰腺横断或结扎大血管之前根治性切除的可行性7，8，9。最近的研究表明，这种动脉优先的方法可以缓解远端胰腺和脾脏静脉充血的形成，并有助于有效控制手术区域的出血;此外，它使SMA周围的淋巴结清扫更充分7，10，11。由于这些原因，动脉优先策略正在成为PD的重要组成部分，并提供了对左侧胰腺癌的洞察。
到目前为止，只有一些用于 L-RAMPS 手术的动脉优先方法被报道5，6。这些方法的核心概念是，在胰腺癌手术期间，应在执行不可逆的手术步骤之前检测肿瘤对SMA的浸润，例如胰实质的横断或大血管的结扎和切除12，13。
在这里，我们开发了L-RAMPS的背尾动脉方法，这可能是安全且有益的胰腺颈肿瘤。我们的程序进一步优化了L-RAMPS程序的常规动脉优先方法，由Yamamoto和Kawabata12，14报告。换句话说，我们首先通过背尾方法 探索 并分离了SMA，这种方法以前从未报道过。该手术的目的和优点是保证胰腺颈体癌手术的可行性和安全性，可能提高R0切除率和进一步预后。
然而，打算使用这种手术的外科医生必须在腹腔镜胰腺手术方面具有丰富的经验。即使他们通过了学习曲线，评估患者的状况（包括肿瘤类型、血管状况和其他参数）也至关重要，因为该过程需要复杂的切除技术。
在本文中，我们介绍了一名 50 岁的 PDAC 男性患者的病例，该患者经内镜超声引导下细针穿刺 （EUS-FNA） 活检确诊，他在术前新辅助化疗后接受了 L-RAMPS。我们的目标是证明使用背尾动脉入路的L-RAMPS的临床安全性和可行性，以及其在胰颈、身体或胰尾PDAC患者中的肿瘤学结果。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>3D Laparoscope</td>
			<td>STORZ</td>
			<td>TC200,TC302</td>
			<td></td>
		</tr>
		<tr>
			<td>Echelon Flex Powered Plus Articulating Endoscopic Linear Cutter and Endopath Echelon Endoscopic Linear Cutter Reloads with Gripping Surface Technology</td>
			<td>Ethicon Endo-Surgery</td>
			<td>ECR60G/GST60G</td>
			<td></td>
		</tr>
		<tr>
			<td>HARMONIC ACE Ultrasonic Surgical Devices</td>
			<td>Ethicon Endo-Surgery</td>
			<td>HAR36</td>
			<td></td>
		</tr>
		<tr>
			<td>Ligating Clips</td>
			<td>Teleflex Medical</td>
			<td>5,44,22,05,44,23,05,44,000</td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasonic Surgical &#38; Electrosurgical Generator</td>
			<td>Ethicon Endo-Surgery</td>
			<td>GEN11CN</td>
			<td></td>
		</tr>
	</tbody>
</table>

laparoscopic radical antegrade modular pancreatosplenectomy via dorsal-caudal artery approach for pancreatic neck-body cancer

腹腔镜胰颈根治性切除术是胰腺癌最复杂的根治性手术之一，尤其是对于接受过新辅助化疗的患者。在这里，我们提出了一种充分利用腹腔镜的高清视觉和手术模式，使用背尾动脉方法进行腹腔镜根治性顺行模块化胰腺脾切除术（L-RAMPS）的技术。
协议中提供了此操作的创新和优化。应优先考虑背切除面，包括肠系膜上动脉（SMA）背侧、胰头背侧、乳糜泻动脉根部（CeA）、左肾血管腹侧和肾门。在胰腺颈体癌手术可行、安全的前提下，第二步是从尾侧到头侧围绕SMA和CeA 进行肿瘤 整体切除，以提高R0（根治零）切除率和进一步预后。

一名上腹部不适和慢性营养不良的 50 岁男性在胰颈中发现了 3.2 cm x 2.5 cm 的肿瘤。他以前很健康，BMI正常（19.9 kg / m2）。
术前影像学评估未发现远处转移、大血管（脾动脉和静脉除外）或淋巴结浸润。行内镜超声引导下细针抽吸术（EUS-FNA）确认PDAC的病理诊断。患者接受了四个周期的新辅助化疗，使用吉西他滨加nab-紫杉醇方案。该药物有助于缓解临床症状，碳水化合...

Watch this Scientific Journal Video about Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer at JoVE.com

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

随着腹腔镜技术的进步，腹腔镜根治性顺行模块化胰腺脾切除术（L-RAMPS）已得到广泛认可。然而，由于该手术中的一些技术困难，L-RAMPS 中的动脉优先入路仍然不常见。在这里，我们开发了L-RAMPS的背尾动脉方法，这可能是安全和有益的胰腺颈部肿瘤。

腹腔镜根治性顺行屈行模块化胰腺脾切除术经背尾动脉 入路治疗 胰腺颈体癌

Laparoscopic radical resection of the pancreatic neck is one of the most complicated radical operations for pancreatic cancer, especially for patients who ...

临床案例。第一，历史。无重大合并症。第二，首席投诉。确诊胰腺癌两个多月。第三，C-A-1-9-9值为每毫升4666.38单位。CEA值正常。第四，CT扫描。胰腺颈体癌的范围是3.2乘以2.5厘米，脾动脉和静脉被侵犯。第五，病理学。进行细针抽吸以确认腺癌的诊断。经过四个周期的新辅助化疗。第一，过去CT。肿瘤最大直径从3.2厘米减小到2.5厘米。体能状态，疼痛，早饱，体重，营养状况的临床改善。第三，C-A-1-9-9从每毫米4，666减少到1，350单位，减少了50%以上。手术技术。将麻醉患者以仰卧位放在手术台上。确保双腿分开。确保第一位外科医生在患者的右侧。第一个助手在左侧，第二个带腹腔镜的助手在患者的双腿之间。此过程采用五端口技术，如图 1 所示。从一开始就进行常规诊断腹腔镜检查，以检查肝脏和腹膜表面是否有额外的胰腺转移。用超声刀打开小囊，将胃结肠韧带分开，距离胃表皮动脉和静脉约2厘米。解剖和切除短胃血管以促进脾切除术。将胃从胰腺表面悬浮在上方。分道扬镳，穿过胰颈后表面与SMV、PV和脾静脉交界处之间的间隙。然后仔细清理该区域，为胰腺交易做准备。抬高横结肠及其肠系膜 执行Kocher操作以暴露左肾静脉的内表面。外科医生在IVC和胰头之间增加了一个间隙。探索 16 号淋巴结站。将整个小肠放在右侧，以提供进入SMA背侧的通道。识别左肾静脉上方的 SMA。然后，沿着左内缘的脂肪周组织平面解剖它，并将其与胰腺分开。在左侧和肾上腺后面的后平面以及左肾表面进行切除范围。暴露左肾静脉。暴露左肾动脉。结扎它并在肾静脉处切断。返回上结肠区域。分离并切除脾结肠韧带和脾周韧带。解剖肝总动脉和胃十二指肠动脉。解剖胃十二指肠淋巴结，然后确定正确的肝动脉。使用橡皮筋将GDA移动到右侧，以暴露门静脉的内表面。分开并穿过胰颈后表面之间的隧道。使用机械吻合器装置横断胰腺腹膜。在手术过程中已进入冷冻病理。结扎并切断脾静脉。为了骨骼肝总动脉，左胃动脉，脾动脉和乳糜泻轴，在清晰的整体胰上淋巴结处解剖。从SMA的尾部到头部部位和乳糜泻轴切除脂肪和纤维组织。从海德堡三角区去除淋巴结，该三角形以门静脉，乳糜泻轴和SMA为界。在此过程中，隔离并分割一系列脾动脉。我们对较大的背侧和尾部空间的描述创造了它。结扎和切断暴露的脾动脉和结扎左胃动脉。暴露左肾静脉以确定背夹层平面。暴露左膈动脉。最后，使用顺行法，解剖远端胰腺和脾脏以及周围的软组织。包装标本。具有代表性的结果。手术总时间为240分钟，失血量为15毫米。术后胰瘘分级为 A.No P-O-D 7术后CT检查发现腹腔积液。排水管在手术后的第八天被拆除。病人的康复并不复杂，术后13天出院。病理学。胰腺导管腺癌中度分化低 边缘阴性。15个淋巴结，无恶性肿瘤。肿瘤分期为T2，N0和M0。结论。腹腔镜根治性顺行模块化胰腺脾切除术通过背尾动脉入路是一种技术上具有挑战性但安全且可重复的胰腺颈椎癌手术。它只能由具有丰富经验的外科医生在大容量中心进行。

Research

JoVE Journal

Medicine

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer

Bioluminescent Orthotopic Model of Pancreatic Cancer Progression

生物荧光原位模型胰腺癌进展

Pancreatic cancer has an extremely poor five-year survival rate of 4-6%.  New therapeutic options are critically needed and depend on improved ...

科研

医学

Carotid Artery Infusions for Pharmacokinetic and Pharmacodynamic Analysis of Taxanes in Mice

颈动脉输液的紫杉烷类化合物在小鼠体内的药代动力学和药效学分析

When proposing the use of a drug, drug combination, or drug delivery into a novel system, one must assess the pharmacokinetics of the drug in the study ...

Studying Pancreatic Cancer Stem Cell Characteristics for Developing New Treatment Strategies

研究胰腺癌干细胞特性开发新的治疗策略

Pancreatic ductal adenocarcinoma (PDAC) contains a subset of exclusively tumorigenic cancer stem cells (CSCs) which have been shown to drive tumor ...

Surgical Approach for Middle Cerebral Artery Occlusion and Reperfusion Induced Stroke in Mice

对大脑中动脉闭塞再灌注损伤诱发中风小鼠的手术方法

Stroke is a leading cause of death worldwide and continues to be one of the major causes of long-term adult disabilities. About 87% of strokes are ...

Middle Cerebral Artery Occlusion Allowing Reperfusion via Common Carotid Artery Repair in Mice

颅内动脉闭塞允许经普通颈动脉修复再灌注的研究

The ischemic stroke is a major cause of adult long-term disability and death worldwide. The current treatments available are limited, with only tissue ...

Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head

胰腺内胰岛素瘤在胰腺头的机器人Enuen

Pancreatic parenchyma sparing surgery for insulinomas avoids the risk of endocrine and exocrine insufficiency, and potential high-risk anastomoses ...

Laparoscopic Radical Left Pancreatectomy for Pancreatic Cancer: Surgical Strategy and Technique Video

胰腺癌的腹腔镜根左造影切除术：手术策略与技术视频

Radical resection margins, resection of Gerota&#8217;s (perirenal) fascia, and adequate lymph node dissection are crucial for an adequate oncological ...

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

机器人辅助基质前体模块化胰腺切除术，包括切除和重建的斯普尔诺-梅森特克结

This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the ...

Direct Drug Delivery to Kidney via the Renal Artery

通过肾脏动脉直接向肾脏输送药物

There is a need for directed injections to enable increased and specific renal exposure for efficient evaluation of drug targets in the renal research ...

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

腹腔镜胰十二指肠切除术使用原 位 非接触式隔离技术治疗胰腺癌

Laparoscopic pancreatoduodenectomy (LPD) is a standard radical operation for pancreatic head malignant tumors by now. Due to the complex laparoscopic ...

腹腔镜根治性顺行屈行模块化胰腺脾切除术经背尾动脉 入路治疗 胰腺颈体癌

腹腔镜根治性顺行屈行模块化胰腺脾切除术经背尾动脉入路治疗胰腺颈体癌