结肠下区肠系膜上动脉优先入路在交界可切除胰头癌外科治疗中的应用价值

The value of superior mesenteric artery preferential approach in the treatment of borderline resectable pancreatic head cancer

目的探讨结肠下区肠系膜上动脉优先入路在交界可切除胰头癌外科治疗中的应用价值。方法回顾性分析2015年1月至2021年12月在首都医科大学附属北京朝阳医院肝胆外科行根治性胰十二指肠切除术的90例交界可切除胰头癌患者的临床及随访资料。结果90例患者在结肠下区探查肠系膜上动脉判断有血管侵犯但符合交界可切除标准后,先断血供再切除组织器官,将受侵血管行切除重建或置换后行常规吻合。所有患者均顺利完成手术,无围手术期死亡。所有患者术后均经病理学检查结果证实为胰腺导管腺癌。结肠下区动脉优先入路组患者术后1、2、3年无瘤生存率为68.2%、60.4%、54.3%,常规入路组患者术后1、2、3年无瘤生存率为58.4%、26.4%、11.7%(P=0.001)。结论结肠下区肠系膜上动脉优先入路可延长交界可切除胰头癌患者术后生存时间,减少复发。

Objective To evaluate superior mesenteric artery preferential approach in the borderline resectable pancreatic head cancer.Methods The clinical and follow-up data of 90 patients with borderline resectable pancreatic head cancer who underwent radical pancreatoduodenectomy at Beijing Chaoyang Hospital,Capital Medical University from Jan 2015 to Dec 2021 were analyzed.Results After exploring the superior mesenteric artery in the lower colon area to confirm the vascular invasion meet the resection criteria,the blood supply is cut off first,then the tumors were resected en bloc,with the invaded vessels resected and reconstructed or replaced.All 90 patients successfully completed the operation without perioperative death.Pathology established pancreatic ductal adenocarcinoma.The 1-year,2-year,and 3-year disease-free survival rates of patients in the arterial priority approach group were 68.2%,60.4%,and 54.3%,while the 1-year,2-year,and 3-year disease-free survival rates of patients by conventional approach were 58.4%,26.4%,and 11.7%(P=0.001).Conclusion The superior mesenteric artery preferential approach in the inferior colon region can prolong the survival time of patients after surgery,and reduce the recurrence.