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Abstract：
BACKGROUND: SMA-first approach in pancreatoduodenectomy (PD) has been widely applied in open surgery as well as laparoscopy. Finding the superior mesenteric artery (SMA), inferior pancreatoduodenal artery (IPDA), first jejunal artery (J1A) has become a great challenge in laparoscopic PD (LPD). Meanwhile, exposing the midde colic artery (MCA) might be a feasible approach to determine SMA, IPDA, and J1A. Our study aims to find the anatomical correlation between MCA and SMA, IPDA, J1A, especially in SMA-first approach LPD from the left.
METHODS: Uncontrolled clinical trial with 33 patients undergoing LPD had preoperative contrast abdominal CT scan to analyze the anatomical relevance between MCA and SMA, J1A, IPDA. The operation was performed starting with exposing MCA in advance to find SMA, J1A and IPDA. The data was analyzed by SPSS 25.0.
RESULTS: 90.9% of MCA started at 12-3 o\'clock from SMA, the mean distance from the SMA root to the MCA and J1A was 56.4 mm and 37.4 mm, respectively. The distance between SMA and J1A was 19 mm. 72.7% J1A started at 9-12 o\'clock, 69.7% J1A and IPDA had a common trunk. 78.8% IPDA started at 3-6 o\'clock. 100% of the cases had J1A controlled intraoperatively, 81.8% for IPDA when approached from the left, 3% had MCA injury. The mean time to approach from the left was 98 min, median blood loss was 100 ml.
CONCLUSIONS: Exposing MCA first helps determine SMA, J1A and IPDA safely, efficiently and faciliates SMA-first approach LPD from the left and complete dissection of the mesopancreas and lymph nodes.
METHODS: Uncontrolled clinical trial with 33 patients undergoing LPD had preoperative contrast abdominal CT scan to analyze the anatomical relevance between MCA and SMA, J1A, IPDA. The operation was performed starting with exposing MCA in advance to find SMA, J1A and IPDA. The data was analyzed by SPSS 25.0.
RESULTS: 90.9% of MCA started at 12-3 o\'clock from SMA, the mean distance from the SMA root to the MCA and J1A was 56.4 mm and 37.4 mm, respectively. The distance between SMA and J1A was 19 mm. 72.7% J1A started at 9-12 o\'clock, 69.7% J1A and IPDA had a common trunk. 78.8% IPDA started at 3-6 o\'clock. 100% of the cases had J1A controlled intraoperatively, 81.8% for IPDA when approached from the left, 3% had MCA injury. The mean time to approach from the left was 98 min, median blood loss was 100 ml.
CONCLUSIONS: Exposing MCA first helps determine SMA, J1A and IPDA safely, efficiently and faciliates SMA-first approach LPD from the left and complete dissection of the mesopancreas and lymph nodes.
摘要：
背景：在胰十二指肠切除术（PD）中，SMA-first入路已广泛应用于开腹手术和腹腔镜手术。发现肠系膜上动脉（SMA），胰十二指肠下动脉(IPDA),第一空肠动脉（J1A）已成为腹腔镜PD（LPD）的巨大挑战。同时,暴露结肠中动脉（MCA）可能是确定SMA的可行方法，IPDA,和J1A。我们的研究旨在发现MCA和SMA之间的解剖学相关性，IPDA,J1A,特别是在SMA-first方法LPD从左边。
方法：对33例接受LPD的患者进行术前对比腹部CT扫描的非对照临床试验，以分析MCA和SMA之间的解剖相关性。J1A,IPDA.该操作是从提前暴露MCA以找到SMA开始的，J1A和IPDA。数据采用SPSS25.0软件进行分析。
结果：90.9%的MCA从SMA的12-3点开始，从SMA根到MCA和J1A的平均距离为56.4mm和37.4mm，分别。SMA和J1A之间的距离为19mm。72.7%J1A在9-12点开始，69.7%的J1A和IPDA有一个共同的树干。78.8%的IPDA在3-6点开始。100%的病例术中J1A控制，从左边接近IPDA的81.8%，3%有MCA损伤。从左边接近的平均时间是98分钟,中位失血量为100ml.
结论：首先暴露MCA有助于确定SMA，J1A和IPDA安全，有效地和方便SMA-first方法LPD从左侧和完整的淋巴结清扫。
方法：对33例接受LPD的患者进行术前对比腹部CT扫描的非对照临床试验，以分析MCA和SMA之间的解剖相关性。J1A,IPDA.该操作是从提前暴露MCA以找到SMA开始的，J1A和IPDA。数据采用SPSS25.0软件进行分析。
结果：90.9%的MCA从SMA的12-3点开始，从SMA根到MCA和J1A的平均距离为56.4mm和37.4mm，分别。SMA和J1A之间的距离为19mm。72.7%J1A在9-12点开始，69.7%的J1A和IPDA有一个共同的树干。78.8%的IPDA在3-6点开始。100%的病例术中J1A控制，从左边接近IPDA的81.8%，3%有MCA损伤。从左边接近的平均时间是98分钟,中位失血量为100ml.
结论：首先暴露MCA有助于确定SMA，J1A和IPDA安全，有效地和方便SMA-first方法LPD从左侧和完整的淋巴结清扫。
