胰体尾肿瘤伴胰源性门静脉高压根治性切除的临床疗效

Clinical outcomes of radical surgery for pancreatic body and tail tumor accompanied with sinistral portal hypertension

目的探讨胰体尾肿瘤伴胰源性门静脉高压（PSPH）患者根治性切除手术的临床疗效。方法对2004年1月至2014年12月收治的胰体尾肿瘤伴PSPH患者的临床资料进行回顾性分析。结果共收治35例伴PSPH的胰腺体尾部肿瘤患者，其中胰体尾癌22例，实性假乳头状瘤12例，无功能性胰岛细胞肿瘤1例。术前检查所有患者均有不同程度的脾肿大和胃底静脉曲张，而肝功能正常。Dopple彩超及术中测脾静脉直径为（1．3±0．3）cm，平均流速为（8．9±0．8）cm／s，压力为（27．3±3．8）cmH2O（1cmH2O=0．098kPa）。本组35胰体尾肿瘤伴PSPH均行根治性手术，22例加作PSPH处理。后者22例中13例作贲门周围血管断流术，9例加作近端胃或全胃切除。本组无围手术期死亡患者。患者术后并发症总发生率为34％（12／35），胰漏5例（14．2％），腹腔感染4例（11．5％），淋巴漏、胃排空延迟和胃穿孔各1例（2．8％）。所有患者术后随访6—60个月，随访6个月内无上消化道出血发生。结论通过多学科协作（MDT）、完善术前评估、围手术期正确处理和实行个体化治疗方案，伴PSPH的胰体尾恶性肿瘤根治性手术也能收到较好的疗效。

Objective To investigate the clinical outcomes of radical surgery for pancreatic body and tail tumors accompanied with sinistral portal hypertension （SPH）. Method The clinicopathological data of 35 patients with pancreatic body and tail tumors accompanied with SPH operated from January 2004 to December 2014 were retrospectively analyzed. Results Of 35 patients, 22 patients had body and tail pancreatic carcinomas, 10 patients had malignant solid pesudopaillary tumors and 1 patients had a neuroendocrine tumor. All these patients developed splenomegaly and varices in the gastric fundus with normal hepatic function. The splenic vein pressure was （ 27.3± 3.8 ） cmH20 （ 1 cmH2O = 0. 098 kPa）, its average diameter was （ 1.3 ±0. 3） cm, and the speed of splenic vein blood flow was （8.9 ± 0. 8） cm/s. Of the 35 patients with pancreatic body and tail tumors who underwent radical resectional operations, 22 patients in addition underwent devascularization. There were 13 of these 22 patients who underwent pericardical devascularization and the remaining 9 underwent total or proximal gastrectomy. The main complications were pancreatic fistula （ n = 5, 14. 2% ）, intra-abdominal infection （ n = 4, 11.5% ）, delayed gastric emptying （ n = 1, 2. 8% ）, lymphatic fistula （n = 1, 2. 8% ） and gastric perforation （n = 1, 2. 8% ）. The post-complication morbidity rate was 34%. All these patients were followed-up for 6 to 60 months after operations. There was no upper gastrointestinal bleeding which occurred within 6 months of operation. Conclusion Multi-disciplinary treatment, complete preoperative evaluation, correct perioperative and individualized management enhanced efficacy in the surgical treatment of patients with pancreatic body and tail tumors with SPH.