选择性动静脉优先处理的根治性胰十二指肠切除术

Prior selective arteriovenous treatment in radical pancreati-coduodenectomy

根治性胰十二指肠切除术是可能治愈胰头恶性肿瘤的惟一有效方法。胰腺钩突部安全、完整性切除是该术式的重点和难点之一。近年来，我们结合国内外胰腺外科的先进经验，根据门静脉、肠系膜上静脉是否被肿瘤侵犯，提出了选择性动、静脉优先处理的根治性胰十二指肠切除术的手术方式和理念。2011年5月至2012年5月，我科采用该方法顺利完成了68例胰头恶性肿瘤的完整根治性切除，取得了满意的疗效。

Radical pancreaticoduodenectomy is the most effective method for the treatment of malignant tumor of pancreatic head. Safe and complete resection of the uncinate process of the pancreas is the most difficult and important part in radical pancreaticoduodenectomy. For the past years, we put forward the new idea of prior selective arteriovenous treatment in radical pancreaticoduodenectomy according to whether the portal vein and superior mesenteric vein was invaded by the tumor. Thin slice scan and vessel reconstruction using multidetector spiral CT can accurately evaluate the condition of the blood vessels near the pancreatic tumor and judge whether the tumor was resectable. By exchanging superior mesenteric artery, controlling blood stream of pancreatic uncinate process and using 3 or 4 vascular blocking bands and the integrated radical resec- tion of uncinate process for those patients can be successfully completed. It can reduce the operating bleeding, operating time and the miscut of superior mesenteric vein and （or） superior mesenteric artery, and also avoid postoperative pancreas necro-sis, infection and hemorrhage caused by the pancreas uncinate process residues, and theoretically reduces the chance of tumor cells spread.