胰腺癌累及肠系膜上动脉外科手术切除的应用价值探讨

Regional Pancreaticoduodenectomy with Superior Mesenteric Artery Resection for Pancreatic Carcinoma:Report of 2 Cases

目的:探讨肠系膜上动脉局部切除在胰腺癌外科治疗中的应用,并评估其可行性。方法:回顾分析2例胰腺癌局部广泛侵润病例,行部分肠系膜上动脉、门静脉和肠系膜上静脉联合切除并重建的手术方法及术后恢复情况,评价其临床效果。结果:2例胰腺癌患者手术过程顺利,病例1SMA部分切除,消化道重建采用child吻合法。病例2行全胰切除,将受侵的SMV、PV、SMA联同胰体癌、全胰、十二指肠、部分空肠及相应区域和腹膜后脂肪组织及淋巴结整块切除,应用脾动脉与肠系膜上动脉端端吻合。肠系膜上动脉分别阻断45min和67min,门静脉阻断31min和55min。术后行B超检查血管通畅,门静脉血流为1 550mL/min和1 620mL/min,术后6个月随访,显示血管重建(脾动脉和肠系膜上动脉)吻合通畅,1例无瘤生存3年2个月,另1例无瘤生存11月。结论:在胰腺癌肿瘤局部侵润肠系膜上静脉、门静脉和肠系膜上动脉时联合切除并行血管修复或脾动脉和肠系膜上动脉重建是一种有效的手术方法。

Objective： TO discuss the surgical treatment of carcinoma of the pancreas with superior mesenteric artery （SMA） invasion. Methods： Vascular resection and reconstruction of the portal vein and hepatic artery were performed in 2 cases, Results： The portal vein （PV）, superior mesenteric vein （SMV） and superior mesenteric artery （SMA） were involved. Dudng surgery, the invaded superior mesentedc vessels were localized. Case 1 underwent pancreaticoduodenectomy with vascular resection, SMA partial resection and reconstruction. Case 2 was submitted to total pancreatic resection with simultaneous vascular resection of spleen artery and SMA reconstruction. No perioperative mortality occurred. Conclusion： Regional pancreaticoduodenectomy with superior mesenteric artery resection is a safe and effective surgical treatment for pancreatic carcinoma.