联合腹腔干切除在胰体尾癌扩大根治术中的应用

Application of combining resection of the celiac axis in extended distal pancreatectomy for pancreatic body-tail carcinoma

目的探讨胰体尾联合腹腔干切除在胰体尾癌扩大根治术中的应用及其效果。方法回顾分析2003-2007年上海交通大学医学院附属瑞金医院普外科10例胰体尾联合腹腔干切除的临床资料。结果胰体尾肿块直径平均(5.0±1.3)cm,中位手术时间320(225～420)min,术中中位出血量900(500～1500)mL;其中3例行肝总动脉重建。术后4例发生胰漏、乳糜漏、腹腔积液、感染等并发症;其中1例死于术后相关并发症。5例术后出现肝功能异常。9例术后住院时间平均(28.8±13.6)d,术后中位存活时间15个月。术后10例均有轻度腹泻(<5次/d),多于术后2～6个月自行好转。6例术前有腰背痛、腹痛,其中5例术后疼痛明显缓解。结论联合腹腔干切除的胰体尾癌扩大根治术是可行、安全的,能够提高胰体尾癌的手术切除率,一定程度延长病人术后生存时间,改善生存质量。

Objective To discuss the application and effect of distal pancreatectomy combined with resection of the celiac axis（CA） for pancreatic body-tail carcinoma. Methods Retrospective analysis the data of 10 patients received pancreatectomy combined with resection of the CA in Rui Jin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January, 2003 to December. 2007. Results The average age is （57.7±6.9） years, the average size of the tumor is （5.0± 1.3） cm, the median operation time is 320 （225-420） min and the median operative blood loss is 900 （500-1500）mL. 3 patients had been performed with CHA reconstruction. There were 4 patients had postoperative complications, including pancreatic fistula, chylous fistula, celiac effusion and infection. One of them died at the 55th day postoperatively. Hepatic dysfunction occured in 5 patients. After operation, the average days in hospital were （28.82 ±13.6） days and the median survival time was 15 months except the died paitent. All patients have had mild diarrhea after surgery（ 〈 5 times/day） and could relieve in 2 - 6 months. 6 patients suffered with abdominal and/or back pain before operation, and 5 of them had achieved relief through operation. Conclusion Distal pancreatectomy combined with CA resection for pancreatic body-tail carcinoma is a viable and safe mode. It can improve the survival time and life quality.