中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (06): 677-682.DOI: 10.19538/j.cjps.issn1005-2208.2025.06.14

• 论著 • 上一篇    下一篇

肠系膜上动脉-腹腔干轴解剖入路与传统入路胰十二指肠切除术的安全性与实用性对比研究

陈江枝1，金凯舟2，叶龙云2，陈    实3，蔡欣然1，陈燕凌1，吴伟顶3   

  1. 1福建医科大学附属协和医院肝胆外科 福建省肝胆外科研究所 福建医科大学肿瘤中心，福建福州 350001；2复旦大学附属肿瘤医院胰腺外科 上海市胰腺癌研究所 复旦大学胰腺癌研究所，上海 200032；3福州大学附属省立医院肝胆胰外科，福建福州 350001
  • 出版日期:2025-06-01 发布日期:2025-07-01

  • Online:2025-06-01 Published:2025-07-01

摘要： 目的    探讨以肠系膜上动脉-腹腔干（SMA-CA）轴为导向的解剖入路在胰十二指肠切除术（PD）中的安全性和有效性。方法  回顾性分析2021年1月至2022年12月在复旦大学附属肿瘤医院、福建医科大学附属协和医院和福州大学附属省立医院行PD手术的294例胰腺癌病人。其中采用以SMA-CA轴为导向解剖（SCGA）组93例，采用传统静脉入路（CVA）组201例。比较两组病人的手术时间、术中出血量、R0切除率、平均受检淋巴结个数、受检淋巴结阳性个数、术后并发症发生率和术后生存时间是否有差异。结果    两组手术耗时差异无统计学意义（P＞0.05）；CVA组的术中出血量和术中输血比例均高于SCGA组［（277.86±143.94）mL vs.（243.12±125.46）mL；28.86% vs. 16.13%］，差异均有统计学意义（P＜0.05）；CVA组R0切除率（88.56%）低于SCGA组（95.70%），差异有统计学意义（P＜0.05）。SCGA组平均受检淋巴结个数和受检淋巴结阳性个数均多于CVA组（17.86枚 vs. 15.42枚；1.99枚 vs. 1.18枚），差异均有统计学意义（均P＜0.05）。两组术后并发症发生率差异无统计学意义（P＞0.05），两组术后生存时间差异无统计学意义（P＞0.05）。结论    SMA-CA轴解剖入路可以提高R0切除率和淋巴结切除率，术后并发症发生率及2年存活率与传统入路相当，因此，SCGA技术在PD术中安全、可行。

关键词: 肠系膜上动脉-腹腔干轴, 静脉入路, 腹腔镜, 胰十二指肠切除术

Abstract: To compare the safety and effectiveness of the superior mesenteric artery-celiac artery (SMA-CA) axis-guided anatomy (SCGA) approach with the conventional venous approach (CVA) in pancreaticoduodenectomy (PD). Methods    A retrospective analysis was conducted on 294 pancreatic cancer patients who underwent PD operation between January 2021 and December 2022 at Fudan University Shanghai Cancer Hospital, Fujian Medical University Union Hospital and Fuzhou University Provincial Hospital. Among them, 93 patients were in the SCGA group, and 201 patients were in the CVA group. The operation time, intraoperative blood loss, R0 resection rate, average number of examined lymph nodes, positive lymph nodes, postoperative complication rate and postoperative survival time were compared between the two groups. Results    There was no significant difference in operative time between the two groups (P>0.05).The intraoperative blood loss mL and blood transfusion volume in the CVA group were both higher than those in the SCGA group mL and ［(277.86±143.94) mL vs. (243.12±125.46) mL; 28.86% vs. 16.13%］, with significant differences (P<0.05).The R0 resection rate in the CVA group (88.56%) was lower than that in the SCGA group (95.70%), with a significant difference (P<0.05).The average number of examined lymph nodes and positive lymph nodes in the SCGA group were both higher than those in the CVA group (17.86 vs. 15.42; 1.99 vs. 1.18), with significant differences (both P<0.05). There was no significant difference in postoperative complication rate between the two groups (P>0.05), and no significant difference in postoperative survival time between the two groups (P>0.05). Conclusion  The SMA-CA axial anatomical approach demonstrates enhanced R0 resection rates and lymph node dissection yields compared to conventional approaches, while maintaining comparable postoperative complication rates and 2-year survival outcomes. These findings confirm that the SCGA technique represents a safe and feasible surgical strategy for PD procedures.

Key words: SMA-CA axial, venous approach, laparoscopic, pancreaticoduodenectomy