联合血管重建的胰十二指肠切除(附42例报告)

Problems of vascular reconstruction combined pancreatoduodenectomy:report of 42 cases.

目的 探讨联合血管重建胰十二指肠切除术的适应证和方法。方法 回顾自 1994年 4月至 2 0 0 1年3月多家协作医院 42例联合血管重建胰十二指肠切除术的经验。 42例行胰十二指肠切除 ,其中 1例胰头癌累及结肠肝曲合并右半结肠切除。全组均联合肠系膜上静脉门静脉 (SMVPV)切除 ,其中合并肠系膜上动脉 (SMA)和肝动脉 (HA)切除重建者分别为 4例和 2例。 1例胰头癌因与下腔静脉前壁粘连紧密不能分开则合并下腔静脉前壁部分切除修复。结果 围手术期死亡 3例 (7 1% )。无胆胰瘘及人工血管感染并发症。病理检查结果 :胰腺神经内分泌恶性肿瘤 1例 ,其余均为腺癌 ,切除血管内膜和胰腺切缘均无肿瘤浸润。失访 2例。随访时间 3～ 87个月 ,7例死于术后 7个月至 3年 ,其中 6例为合并SMA、HA切除重建者 ,存活超过 3年 19例 ,超过 5年 6例。其余病例尚在随访中。结论 在选择适宜的病例中施行联合切除血管的胰头癌根治术可提高其切除率 。

Objective To evaluate the surgical indications and method for regional pancreatoduodenectomy combined reconstruction of blood vessel.Methods To review our experience of forty-two patients undergoing pancreatoduodenectomy combined major vessel reconstruction between April 1994 and March 2001.Forty two cases underwent pancreatoduodenectomy.One case combined right hemicolectomy. Combined SMVPV reconstruction was done in 42 cases. Among them comcomitants SMA and HA reconstruction were 4 and 2 respectively. Combined ICV reconstruction was done in one case.Results The overall mortality was 7.1%, no complications, resection endothelium or margins of the blood vessel and pancreas were microscopically tumor free in all cases. Histological specimen examinations demonstrated that 41 cases were adenocarcinoma of pancreas head, one case was neuroendocrine adenocarcinoma. With follow-up 3～87 months,survival time after PV/SMV reconstruction for pancreatoduodectomy was more than 5 years in six patients, more than 3 years 19 cases.Conclusion The treatment of pancreatoduodenectomy combined reconstruction blood vessel can be performed safely without increasing morbidity and mortality but increased excision rates and prolong survival time in carefully selected patients with pancreatic cancer.