浸润门静脉区域的癌肿整块切除的临床研究

Clinical study on en bloc resection of carcinoma involving regional portal vein

目的许多近、远端胆管癌及壶腹周围癌的病人因血管受侵犯而丧失手术切除机会,本研究为提高手术切除率,延长生存期,改善病人生活质量而设计。方法 1990年3月～1996年10月,作者对50例近端胆管癌切除术和47例壶腹周围癌胰十二指肠切除术中的19例浸润了门静脉的患者,分别采用联合门静脉长度1.0～1.5cm;门静脉与肠系膜上静脉及脾静脉汇合部切除5例,切除长度2.0～4.0cm,门静脉侧壁切除5例。均行对端吻合成功。结果 19例中,17例恢复顺利,随访4～29个月,平均14个月,四例生存时间超过一年。围手术期死亡2例(10.5%)。结论癌肿浸润门静脉主干不超过2cm,浸润门静脉及肠系膜上静脉汇合部不超过5cm,无远处转移,可联合门静脉切除并行对端吻合是可行的。

Objective To improve the resection rate of proximal and distal cholangiocarcinoma and periampullary cancer,so as to extend the patient's survival time and improve the life quality.Meth- ods From Mar.1990 to Oct.1996,we operated 50 cases with hilar cholangiocarcinectomy and 47 cas- es with pancreaticoduodenectomy.Among these 97 patients,19 cases of carcinoma involving the region- al PV received PV resection and reconstruction simultaneously.Patients subjected to PV resection in- cluded 3 cases of PV bifurcation and left hepatic lobe resection,6 cases of PV trunk resection for 1.0— 2.5cm,5 cases of PV,spleenic vein and SMV confluence region resection for 2.0—4.0cm,and 5 cases of PV lateral wall partial resection.All veins underwent end-to-end anastomosis.Results Among the 19 patients,17 recovered smoothly.The follow-up period was 4—29 months(averaged 14 months). The longest survival time was more than 3 years and perioperative death occurred in 2 patients (10.5%).Conclusions Carcinoma involving PV no more than 2cm or involving confluence region of PV and SMV no more than 5cm without distant metastasis can be operated with combination resection of carcinoma and vein with end-to-end anastomosis directly.