腹腔鏡下膵頭十二指腸切除術における上腸間膜動静脈周囲へのArtery first approach

Artery first approach to the superior mesenteric vessels in laparoscopic pancreaticoduodenectomy

◆要旨：膵頭十二指腸切除術（PD）のなかでも膵鉤部と上腸間膜動静脈との間を切離する手技は最も難度が高く，開腹手術でも様々な手技の工夫が行われている．筆者らは腹腔鏡下手術の利点である尾側からの拡大視野を活かした空腸起始部側からのArtery first approachを用いて腹腔鏡下PDにおける同手技を標準化した．これまで7例に施行し，手術時間，出血量，術後在院日数の中央値は526分，24ml，20日で，致命的な合併症は認めず，良好な成績が得られている．筆者らの手技の要点を報告する．

In pancreaticoduodenectomy, dissection of the uncus of the pancreas from the mesenteric vessels is the most difficult procedure. Therefore, various surgical approaches have been devised and adopted, even in open surgery. In laparoscopic pancreaticoduodenectomy（Lap-PD）, we employ the artery first approach from the side where the jejunum originates because of the advantage of having magnified view from the caudal side. In the seven cases of Lap-PD by the artery first approach undertaken at our hospital, the median operative time, blood loss, and postoperative hospital stay were 526min, 24ml, and 20 days, respectively, and there were no life-threatening complications. We report our techniques for the artery first approach in Lap-PD.