异体血管移植技术用于门静脉受累的胰腺癌根治术的近中期随访评价

The short and medium-term follow-up of allograft of blood vessel during radical resection for pancreatic cancer with portal vein involvement

目的评价异体血管移植技术用于门静脉受累的胰腺癌根治术的近中期疗效。方法回顾性分析2013年3月至2017年5月择期行胰腺癌根治术的22例门静脉受累的胰腺癌患者资料,术中应用异体血管移植技术,术后均获随访。按植入血管形态不同分为I型组(15例)、Y型组(7例)。采用SPSS 24.0软件进行数据处理,围术期各项指标以(x^-±s)表示,采用独立t检验;术后病理学检查结果、并发症及术后近中期生存率等采用χ^2检验,P<0.05为差异具有统计学意义。结果两组患者手术时间、切除血管长度、住院时间相比,差异无统计学意义(P>0.05);I型组出血量、门静脉阻断时间比Y型组少(P<0.05);术后病理学检查结果证实22例患者均为胰腺恶性肿瘤且R0切除率为81.8%,并发症总发生率为22.7%(5/22);术后平均生存期(15.2±1.1)个月;I型组、Y型组术后3、6、12个月无病生存率相比,差异无统计学意义(P>0.05)。结论异体血管移植技术用于门静脉受累的胰腺癌根治术中R0切除率高、并发症少、生存率高;I型血管植入出血量低、门静脉阻断时间短,Y型可为部分较复杂的门脉系统重建提供替代物。

Objective To evaluate the short and medium-term efficacy of allograft of blood vessel during radical resection for pancreatic cancer with portal vein involvement.Methods 22 patients with pancreatic cancer with portal vein involvement received selective radical resection for pancreatic cancer in our hospital from March 2013 to May 2017 were selected and analyzed.They were given intraoperative allograft of blood vessel and postoperative follow-up.All patients were divided into type I group(15 cases)and type Y group(7 cases)according to the implanted vascular morphology.SPSS 24.0 software was used for data processing,the perioperative indexes were expressed as(±s),and the independent t test was adopted.The postoperative pathological findings,complications and postoperative short and medium-term survival rate werecompared withχ^2 test,and P<0.05 was considered statistically significant.Results There was no statistical difference in the operation time,length of vessel resection,hospital stays between the two groups groups(P>0.05);The bleeding volume and portal vein block time in type I group were lower than those in type Y group(P<0.05);The postoperative pathological results confirmed that the R0 resection rate of 22 patients with malignant pancreatic cancer was 81.8%,and the total incidence of complications was 22.7%(5/22);The postoperative mean survival time was(15.2±1.1)months;There was no statistical difference in the postoperative 3,6,12 m disease free survival between type I group and type Y group(P>0.05).Conclusion Allograft of blood vessel during radical resection for pancreatic cancer involving portal vein has high R0 resection rate,less complications and high survival rate;Type I vascular implantation has lower bleeding volume and shorter portal vein block time,while type Y vascular implantation can provide the substitutes for some complicated portal system reconstruction.