胰十二指肠切除联合血管重建治疗胰头、十二指肠恶性肿瘤

The feasibility of pancreatoduodenectomy with vascular reconstruction to treat pancreatic and duodenal tumor

背景与目的:胰头癌、十二指肠癌的治疗,手术切除仍是唯一可能根治的有效方法。但临床确诊时,多数为晚期,常累及门静脉/肠系膜上静脉、下腔静脉即属手术禁忌症。本研究旨在探讨累及门静脉/肠系膜上静脉、下腔静脉的胰头癌、十二指肠癌切除的处理方法,以提高切除率及生存率。方法:总结2002年2月—2005年6月5例联合血管重建胰十二指肠切除术的临床资料及经验,其中胰头癌合并门静脉/肠系膜上静脉切除人工血管重建3例,十二指肠癌合并下腔静脉切除人工血管重建2例。结果:本组病例无围手术期死亡。无人工血管感染、阻塞并发症。随访10个月死亡1例,24个月死亡1例,术后存活超过3年2例,超过4年1例。结论:对累及门静脉/肠系膜上静脉、下腔静脉的胰头癌、十二指肠癌行胰十二指肠切除联合血管重建手术是安全的,可提高肿瘤切除率,延长患者生存时间。

Background and purpose： Radical surgery remains the main treatment for the patients with pancreatic and duodenal cancer, but resectability rate is low when clinically diagnosed, portal vein/superior mesenteric vein or inferior caval vein invaded by tumors are a few of the main reasons. How to increase resectability of pancreatic cancer and duodenal cancer still is very challenging to the clinician. This study was clone to explore the feasibility of the new surgical approach for the treatment of pancreatic and duodenal cancer with portal vein/superior mesenteric vein or inferior caval vein invasion. Methods： 5 patients received pancreatoduodenectomy with vascular reconstruction between February 2002 and June 2005. Three patients with pancreatic head cancer underwent pancreatoduodenectomy combined with portal vein/SMV resection and vascular reconstruction and two patients with duodenal cancer underwent pancreatoduodenectomy combined with inferior caval vein resection and vascular reconstruction. Results： There was no surgery related death. The serious complications such as artificial blood vessel infections or obstructions were not experienced. After surgery, one patient died 10 months later, one patient died 24 months later, two patients survived for over 3 years and one patient over 4 years. Conclusions： Pancreatoduodenectomy with vascular reconstruction for patients with carcinoma of the pancreatic head or duodenum invading portal vein/superior mesenteric vein or inferior caval vein has been proved to be a safe treatment, it could improve the resectability of the tumor and prolong survival.