动脉优先入路联合根治性顺行模块化胰脾切除术在胰体尾癌联合多脏器切除术中的应用

Application of arterial priority approach combined with radical anterograde modular pancreaticosplenectomy in combined multiple organ resection of pancreatic body and tail cancer

目的探讨动脉优先入路联合根治性顺行模块化胰脾切除术在胰体尾癌联合多脏器切除术中的应用价值。方法2014年12月~2022年1月我院施行胰体尾癌联合多脏器切除的病人12例,术前依据CT或者MRI平扫+增强进行评估,术中采用动脉优先入路联合根治性顺行模块化胰脾切除术,同时联合多脏器切除漏。结果所有病人均顺利完成手术,无围手术期死亡。手术时间(375±43)分钟,术中出血量(280±40)ml。术后病理检查提示所有标本切缘均为阴性,神经均受累,清扫淋巴结(23±6)枚,12例中10例出现淋巴结转移。术后并发症发生率50%,其中A级胰漏3例,无B、C级胰漏,胃排空障碍1例,淋巴漏1例,粘连性肠梗阻1例,均采取保守治疗治愈。无结肠吻合口漏和肾皮质危象发生。全组病人均痊愈出院,平均住院18.6天。结论采用动脉优先入路联合根治性顺行模块化胰脾切除术,施行胰体尾癌联合多脏器切除,保证了肿瘤的根治性切除,术中出血少,安全可行。

Objective To investigate the value of arterial priority approach combined with radical anterograde modular pancreaticosplenectomy in the resection of pancreatic body and tail cancer combined with multiple organs.Methods The clinical data of 12 patients with pancreatic body and tail cancer combined with multiple organ resection in Taizhou People’s Hospital Affiliated to Nanjing Medical University from December 2014 to January 2022 were analyzed retrospectively.Preoperative evaluation was based on CT or MRI plain scan plus enhancement.During the operation,arterial priority approach combined with radical anterograde modular pancreaticosplenectomy was used,and combined with multiple organ resection.Postoperative complications were treated in time.Results All patients were successfully completed surgery,no perioperative death.The operation time was(375±43)min and the amount of intraoperative bleeding was(280±40)ml.Postoperative pathology showed that the cutting edges of all specimens were negative,nerves were involved,lymph nodes were cleaned(23±6),and lymph node metastasis occurred in 10 of 12 cases.The incidence of postoperative complications was 50%,including 3 cases of grade A pancreatic fistula,no grade B and C pancreatic fistula,1 case of gastric emptying disorder,1 case of lymphatic fistula and 1 case of adhesive intestinal obstruction,which were cured by conservative treatment.No colonic anastomotic leakage and renal cortical crisis occurred.All patients were cured and discharged,with an average hospitalization of 18.6 days.Conclusions Using the method of arterial priority approach combined with radical anterograde modular pancreaticosplenectomy,pancreatic body and tail cancer combined with multi organ resection ensures the radical resection of the tumor,less intraoperative bleeding,safe and feasible.