门静脉冷灌注下全胰切除术

Total pancreatectomy combined with cold perfusion of liver via portal vein

全胰切除术是胰腺恶性肿瘤累及后腹膜但无肝转移患者治疗的绝对适应证。但联合部分门静脉主干肠系膜上血管切除的全胰切除术需要进行门静脉血流阻断，若阻断时间过长，使术前已合并梗阻性黄疸的患者在术后极易发生肝功能不全，甚至肝功能衰竭。我们应用门静脉冷灌注技术，为一例肠系膜上血管受侵犯的患者成功实施了全胰切除术，效果良好。

Cold perfusion of liver can significantly alleviate the ischemia-reperfusion injury caused by hepatic blood flow occlusion. We have modified the technique of cold perfusion of liver and applied it to total pancreateetomy for patients with pancreatic head carcinoma complicated with metastasis to the body and tail of pancreas and with portal invasion. After skeletoniza- tion of the hepatoduodenal ligament, the amputation of the portal vein and blockage of the superior mesenteric vein were performed before portal perfusion. Meanwhile, pancreatic head resection, duodenectomy, subtotal gastrectomy and partial resection of the superior mesenteric vein and portal vein were carried out. Superior mesenteric vein and portal vein bypass grafting was achieved with artificial vessels. The digestive tract was reconstructed after it was freed of the spleen and resection of the body and tail of pancreas to the left side of superior mesenteric vein, greater omentum and intestine from the end of the colon to splenic flexure of colon. The patient was followed up for 3 months, and the general condition was good, although diarrhea frequently occurred. No tumor metastasis occurred.