胰头癌联合门静脉区域切除的临床价值

Regional pancreaticoduodenectomy with portal vein resection in patients with pancreatic head carcinoma

目的探讨胰腺癌联合门静脉区域切除的临床价值,及评价区域切除术中肿瘤侵犯门静脉后以颈内静脉替代门静脉的效果。方法回顾性分析2000年1月—2003年1月间天津医科大学附属肿瘤医院6例行胰头癌联合门静脉切除并用颈内静脉替代门静脉修复的患者的临床资料。结果本组6例行胰头癌联合门静脉切除并用颈内静脉替代门静脉修复,术后病理均证实肿瘤侵犯累及门静脉和/或肠系膜上静脉,术后生存时间17～49个月,平均23.2个月,其中2例存活超过3年,最长的1例术后无瘤生存达4年1个月。结论对于胰头癌局部浸润肠系膜上静脉和/或门静脉,但无远处转移的患者,应积极行手术切除。胰腺癌联合门静脉切除后,行颈内静脉替代门静脉修复是一种有效的方法,可以提高于术切除率,减少术后并发症,延长患者生存期。

Objective To evaluate operative efficacy in regional pancreaticoduodenectomy with mesenteric-portal vein resection and graft reconstruction using internal jugular vein for pancreatic head carcinoma. Methods From Jan 2000 to Jan 2003, 6 patients with pancreatic head tumors and mesenteric- portal vein involvement underwent regional pancreaticoduodenectomy with mesenteric-portal vein resection and vascular reconstruction using internal jugular vein. Results Surgery was successful in all 6 patients. Postoperative pathology revealed that mesenteric vein or portal vein were invaded by tumor in all cases. Survival time ranged from 17 to 49 months. The median survival was 23.4 months. Two cases have survived over 3 years and one of them was alive 49 months postoperatively without recurrence. Conclusion The regional pancreaticoduodenectomy with tumor invaded mesenteric-portal vein resection and graft reconstruction by using internal jugular vein renders a longer survival in metastasis-negative patients of pancreatic head adenocarcinoma.