同种异体血管移植在胰十二指肠切除联合肠系膜上静脉和门静脉部分切除术中的应用

Application of vascular allotransplantation in the pancreaticoduodenectomy combined with partial resection of superior mesenteric vein and portal vein

目的：探讨同种异体血管移植在胰十二指肠切除联合肠系膜上静脉和门静脉部分切除术血管重建中的应用价值。方法：回顾性分析2014年8月和10月中山大学附属第一医院收治的2例行胰十二指肠切除联合肠系膜上静脉和门静脉部分切除术的胰头癌患者的临床资料。病例1血型A型，病例2血型O型。术中均发现肿瘤包裹肠系膜上静脉和门静脉，包裹长度分别为6 cm，决定行胰十二指肠切除联合肠系膜上静脉和门静脉部分切除术及同种异体血管（血型B型）移植。采用门诊和电话方式进行随访，随访内容为患者肿瘤转移、复发情况。随访时间截至2015年6月。结果：2例患者均顺利完成手术，围术期无并发症发生。病例1手术时间为480 min，脾静脉阻断时间为45 min，肠系膜上静脉和门静脉阻断时间为 30 min，术中出血量为3 000 mL，术中输RBC 10 U，血浆600 mL。血管切除长度为7 cm。术后患者恢复顺利，术后第5天恢复进食，第5、7天拔除腹腔引流管，第21天出院。术后患者至随访截止时间仍生存，未见肿瘤复发。病例2手术时间为480 min，脾静脉阻断时间为30 min，肠系膜上静脉和门静脉阻断时间为 25 min，术中出血量为600 mL，术中输RBC 2U，血浆400 mL。血管切除长度为7 cm。术后患者恢复顺利，术后第5天恢复进食，第5、 7天拔除腹腔引流管，第14天出院。至随访截止时间仍生存，未见肿瘤转移和复发。结论：同种异体血管移植应用于胰十二指肠切除联合肠系膜上静脉和门静脉部分切除术的血管重建，安全可行，近期疗效满意。

Objective：To investigate the application value of vascular allotransplantation in the pancreaticoduodenectomy combined with superior mesenteric vein and/or portal vein （SMV/PV） partial resection and vascular reconstruction. Methods：The clinical data of 2 patients with pancreatic head carcinoma who underwent pancreaticoduodenectomy combined with SMV/PV partial resection at the First Affiliated Hospital of Sun Yatsen University between August 2014 and October 2014 were retrospectively analyzed. The blood types of case 1 and case 2 were types A and O. Since SMV/PV surrounded by tumor was detected during the operation with the length of surrounded part of 6 cm, and pancreaticoduodenectomy combined with SMV/PV partial resection and vascular allotransplantation were performed. Two cases were followed up by outpatient examination and telephone interview till June 2015. The index observed during the followup included tumor metastasis and recurrence. Results：Two cases underwent successful operation without perioperative complications. The operation time, splenic vein occlusion time, SMV/PV occlusion time, volume of intraoperative blood loss, volume of red blood cell （RBC） transfusion, volume of plasma transfusion and length of resected blood vessel were 480 minutes, 45 minutes, 30 minutes, 3 000 mL, 10 U, 600 mL and 7 cm in case 1 and 480 minutes, 30 minutes, 25 minutes, 600 mL, 2 U, 400 mL and 7 cm in case 2. Two cases took food at postoperative day 5, abdominal drainage tube was removed at postoperative day 5 and 7 with good recovery. Case 1 and Case 2 were discharged from hospital at postoperative day 21 and 14, respectively. Two cases had good survival without metastasis and recurrence of tumors at the end of followup.Conclusion：Vascular allotransplantation is safe and feasible in the pancreaticoduodenectomy combined with SMV/PV partial resection for pancreatic head carcinoma, with a satisfactory shortterm outcome.