胰十二指肠联合门静脉切除治疗胰头癌

Pancreatoduodenostomy combined with resection of PV/SMV for carcinoma of head of pancreas

目的探讨联合门静脉和（或）肠系膜上静脉（PV／SMV）切除的胰十二指肠切除治疗胰头癌的安全性和疗效。方法回顾分析12例胰头癌施行包括受侵PV／SMV在内的胰十二指肠切除术的临床资料，并与同期40例胰头癌行标准胰十二指肠切除术进行比较。结果联合PV／SMV切除的12例中3例行血管段切除、人造血管移植，3例行血管段切除、血管端端吻合，6例行血管壁部分切除后修复。与同期40例行标准胰十二指肠切除术进行比较，两组在年龄、性别、手术时间、术中出血、手术并发症、手术病死率、肿瘤大小、肿瘤分化程度、淋巴结转移、切缘阳性率及中位生存期无统计学差异。结论联合PV／SMV切除的胰十二指肠术不会增加手术病死率和手术并发症，是安全可行的术式；胰头癌单纯侵犯PV／SMV不是手术的禁忌证，联合PV／SMV切除能获得较好的疗效。

Objective To investigate the safety and feasibility of panereatoduodenostomy combined with resection of PV/SMV for carcinoma of the head of pancreas. Methods The clinical data of 12 cases of carcinoma of the haed of pancreas underwent pancreatoduodenostomy in combination with resection of PV/SMV were retrospectively analyzed. Their data were compared with those of 40 cases of carcinoma of the haed of pancreas underoing pancreatoduodenostomy in the same period of time. Results Of the 12 cases, 3 underwent PV resection and reconstruction with ePTEE grafts, 3 PV resection and reconstruction with end-end anastomosis, 6 PV lateral wall partial resection and reconstruction. There were no significantly differences in age, sex, time of operation, operative bleeding, complication, mortality rate, site of tumor, tumor differentiation, lymphtic metastasis, margin positive resection and survival between the two groups. Conclusion Pancreatoduodenostomy combined with resection of PV/SMV is safe for carcinoma of the head of pancreas.