胰十二指肠切除术联合血管切除的术前、术中评估和操作要点

Preoperative and Intraoperative Evaluation and Operative Methods of Pancreaticoduodenectomy Combined with Vascular Resection

目的 探讨开展胰十二指肠切除术联合血管切除的术前、术中评估和操作方法。方法 应用术前T分级评估方法分析我院2002年1月至2005年6月期间226例胰头癌手术患者的资料，探讨胰十二指肠切除术合并血管切除的准确评估方法和操作要点。用SAS6．12软件包行X^2检验对计数资料进行分析。结果 术前各T分级评估的符合率在85．00％以上，术前应用T分级评估胰头癌与其血管关系的准确性为80．97％；随着术前T分级评估的提高，需合并血管切除才能达到标准或区域性胰十二指肠切除术的比例也明显增加（P〈0．001）。手术均顺利，血管切除重建均在12～46min内完成，围手术期并发症率为19．61％，死亡率为1．96％。结论 专业外科医生的不断实践和经验积累结合先进的影像学检查技术可以进行较为准确的术前T分级评估，这有助于术者准确把握手术适应证和制定更为合理的手术方案。术中准确的评估，细致的解剖操作，对成功开展合并受侵血管切除的胰十二指肠切除术至关重要。

Objective To investigate the preoperative and intraoperative evaluation and the operative methods of pancreaticoduodenectomy combined with resection of involved blood vessel. Methods The materials of 226 cases of carcinoma of head of pancreas, which were collected from January 2002 to June 2005, were assessed according to the T-grade evaluative method and were summarized into a more accurate method of preoperative and intraoperative evaluation and an operative method of the pancreaticoduodenectomy combined with vascular resection. The statistical analyses were performed by SAS 6.12 Star software package with X^2 test for categorical data. Results The coincidence of every preoperative evaluations on pancreaticoduodenectomy with T-grade method were more than 85.00% and the accurate rate of evaluation on relationship between tumor and blood vessel was 80.97%. As the degree of T-grade increased, the proportion of requiring pancreaticoduodenectomy combined with vascular resection increased significantly as well （P〈0. 001）. All operations were smoothly clone and the reconstruction of removed vascular took 12 to 46 minutes. The complication rate and the mortality rate of perioperative period were 19. 61% and 1.96%, respectively. Conclusion With more practice, experience and the advanced imaging technology, it is possible for professional surgeon to evaluate more accurately on the pancreaticoduodenectomy combined with vascular resection by using the preoperative T grade method. T-grade evaluative method is useful for operator to assess the indication accurately and to design the operative schedule reasonably. Accurate operational evaluation and careful operation are also important for pancreatoduodenectomy combined vascular resection.