PDF(Pubmed)
Abstract：
Careful preoperative planning is key in minimally invasive radical antegrade modular pancreatosplenectomy (MI-RAMPS). This retrospective study aims to show the practical implications of computed tomography distance between the right margin of the tumor and either the left margin of the spleno-mesenteric confluence (d-SMC) or the gastroduodenal artery (d-GDA). Between January 2011 and June 2022, 48 minimally invasive RAMPS were performed for either pancreatic cancer or malignant intraductal mucinous papillary neoplasms. Two procedures were converted to open surgery (4.3%). Mean tumor size was 31.1 ± 14.7 mm. Mean d-SMC was 21.5 ± 18.5 mm. Mean d-GDA was 41.2 ± 23.2 mm. A vein resection was performed in 10 patients (20.8%) and the pancreatic neck could not be divided by an endoscopic stapler in 19 operations (43.1%). In patients requiring a vein resection, mean d-SMC was 10 mm (1.5-15.5) compared to 18 mm (10-37) in those without vein resection (p = 0.01). The cut-off of d-SMC to perform a vein resection was 17 mm (AUC 0.75). Mean d-GDA was 26 mm (19-39) mm when an endoscopic stapler could not be used to divide the pancreas, and 46 mm (30-65) when the neck of the pancreas was stapled (p = 0.01). The cut-off of d-GDA to safely pass an endoscopic stapler behind the neck of the pancreas was 43 mm (AUC 0.75). Computed tomography d-SMC and d-GDA are key measurements when planning for MI-RAMPS.
摘要：
仔细的术前计划是微创根治性顺行模块化胰脾切除术（MI-RAMPS）的关键。这项回顾性研究旨在显示肿瘤右缘与脾系膜汇合（d-SMC）或胃十二指肠动脉（d-GDA）的左缘之间的计算机断层扫描距离的实际意义。在2011年1月至2022年6月之间，对胰腺癌或恶性导管内粘液性乳头状肿瘤进行了48例微创RAMPS。两个程序转换为开放手术（4.3％）。平均肿瘤大小为31.1±14.7mm。平均d-SMC为21.5±18.5mm。平均d-GDA为41.2±23.2mm。10例患者（20.8％）进行了静脉切除术，在19例手术中（43.1％）无法通过内窥镜吻合器分割胰颈。需要静脉切除的病人,平均d-SMC为10mm(1.5-15.5),无静脉切除者为18mm(10-37)(p=0.01).进行静脉切除的d-SMC的截止值为17mm(AUC0.75)。当无法使用内窥镜吻合器分割胰腺时，平均d-GDA为26mm（19-39）mm，和46毫米（30-65）时，胰腺的颈部被缝合（p=0.01）。d-GDA在胰腺颈部后安全通过内窥镜吻合器的截止值为43mm(AUC0.75)。计算机断层扫描d-SMC和d-GDA是计划MI-RAMPS时的关键测量值。
