门静脉、肠系膜上静脉的解剖与临床应用的初步研究

PRELIMINONY STUDY OF CLINICAL APPLICA- TION AND ANATOMICAL IN THE PORTAL VEIN AND SUPERIOR MESENTERIC VEIN

目的 为提高肝门胆管癌和壶腹周围癌的手术切除率,使该区域受肿瘤浸润的血管能同时切除,血管直接重建提供解剖学依据.方法 在实施肝门胆管癌切除术及胰十二指肠切除术中,对病人的肝蒂内门静脉干、胰腺钩突内的肠系膜上静脉干进行解剖学定位并分段测量长度及可以纵向折叠的长度,以此估计可切除的静脉长度及重新再建血管的长度.结果 测量肝蒂内门静脉干104例,男性(5.8±1.99)cm,女性(5.5±O.81)cm,优势长度大于4.5cm者,男性56例占76.7%,女性25例占80.6%.胰腺钩突内段肠系膜上静脉干测量54例,男性(3.7±0.77)cm,女性(3.5±0.64)cm,优势长度大于3.0cm者,男性28例占77.6%,女性14例占77.8%.门静脉纵向折叠移动的范围在1.8～4.2cm,平均折叠2.2(1.8～2.4)cm者占66.3%,平均折叠2.8(2.5～4.2)cm者占33.7%.切除胰十二指肠后胰腺钩突内肠系膜上静脉段纵向折叠范围平均4.0cm,最长达5.2cm.结论 肝门胆管癌和壶腹周围癌切除术合并受浸血管切除在一定范围是可行的.

Objective: To improve the resectability rate of the proximal cholangio-carcinoma and malignent tumors of periampullary region, the length of the superior mesenteric vein(SMV) behind the uncinate process and the portal vein (PV) were measured, and the longitudinal flexure of the SMV and PV were measured too. It can provide an anatomic support for vessel end-to-end anastomosis after EN Bloc regional tumor resection combined with these vessel. Methods: 50 patients with proximal cholangio-carcinoma and 47 patients with periampullary cancer underwent surgery, during operation the follow data were measured: (1) the length of SMV from the Henle's trunk to the superior mesenteric-spleen vein confluence, as a 'post-pancreas trunk' (PPT). (2) the length of superior SM-spleen vein confluence to inferior portal vein bifurcation. (3)the range of longitudinal flexure of the PPT and PV. Results: The SMV behind the uncinate process were measured in 54 specimens, the length is 2.4-5.6cm. In 36 males the average length is 3.7cm, and 28 patients longer than 3.0cm(77%). In 18 females the average length is 3. 5cm, and 14 patients longer than 3. 0cm (77. 8%). After pancreatoduo-denectomy the average length of longitudinal flexure of the vessel is 4.0cm, the longest is 5.2cm. The PV were measured in 104 specimens, the range is 3.6-7.4cm. in 73 males the average is 5. 8cm, 56 patients longer than 4. 5cm (76. 7%), in 31 females the average length is 5.5cm, and 25 patients longer than 4.5cm(80.6%),the range of longitudinal flexure of the PV is 1.8 - 4.2cm, In 69 patients the average length is 2. 2cm (1.8-2.4cm, 66.3%), in 35 patients the average length is 2.8cm (2.5-4.2cm, 33.796). Conclusion: This study provide a clinical anatomic evidence for proximal cholangiocarcinoma and ampullary cancer to undergo En Bloc regional tumor resection combined with the PPT of SMV or PV and undergo directly end-to-end anastomosis.