摘要
目的探讨胰十二指肠切除术(pancreaticoduodenectomy,PD)联合门静脉(portal vein,PV)/肠系膜上静脉(superior mesenteric vein,SMV)切除重建治疗胰腺癌并PV/SMV受侵的手术方式和临床价值。方法回顾性对比分析2014年1月至2017年4月收治的21例胰腺癌并侵犯PV/ SMV患者(A组)与同期62例PV/SMV未受侵犯的胰头癌患者(B组)行PD治疗的临床资料和术后随访资料,两组患者均无腹腔动脉、肝总动脉、肠系膜上动脉侵犯。A组行PD术同时切除受侵的PV/SMV血管并重建,B组仅行PD术治疗,比较两组患者术后并发症发生率和术后生存时间。结果A组患者术后平均生存时间19.2个月,1年以上生存率57.1%(12/21),2年以上生存率28.6%(6/21),3年及以上生存率14.3%(3/21);B组患者的平均生存时间19.4个月,1年以上生存率58.1%(36/62),2年以上生存率30.6%(19/62),3年及以上生存率14.5%(9/62),两组术后1、2、3年存率比较差异均无统计学意义(均P>0.05)。结论胰腺癌并PV/SMV受侵,行PD联合PV/SMV切除并血管重建是安全可行的,其手术重建方式根据受侵血管位置、长度来确定,其术后并发症发生率和术后生存时间与PV/SMV血管未受侵胰头癌PD手术并无明显差别。
Objective To investigate the clinical value and surgical methods of pancreaticoduodenectomy (PD) combined with portal vein (PV)/superior mesenteric vein (SMV) resection and reconstruction in the treatment of pancreatic cancer with PV/SMV invaded by tumor. Methods The clinical data of 21 patients of pancreatic cancer with PV/SMV invaded by tumor (group A) and 62 patients of pancreatic head cancer without PV/SMV invaded by tumor (group B) in the same period were collected and analyzed retrospectively from Jan 2014 to Apr 2017.There were no distinct invasion of celiac artery (CA),hepatic common artery (HCA) and superior mesenteric artery (SMA) in two groups of pancreatic cancer patients.The patients of group A underwent PD combined with PV/SMV resection and reconstruction,and the patients of group B were only treated with PD surgery.The complication rate and overall survival time after PD was compared between the 21 patients of pancreatic cancer with PV/SMV invaded by tumor and the 62 patients of pancreatichead cancer without PV/SMV invaded by tumor.' Results The average overall survival time of 21 patients of pancreatic cancer with PV/SMV invaded by tumor (group A) was 19.2 months,specifically with 1-year survival rate of 57.1% (12/21),2-year survival rate of 28.6% (6/21),and 3-year survival rate of 14.3% (3/21).Meanwhile,the average overall survival time of group B was 19.4 months,specifically with 1-year survival rate of 58.1% (36/62),2-year survival rate of 30.6% (19/62),and 3-year survival rate of 14.5% (9/62).The results indicated that no differences for overall survival time of patients treated with PD including 1,2,3-year survival rate between two groups were found (P>0.05). Conclusions For pancreatic cancer accompanied by PV/SMV invasion without invasion of SMA,CA and HCA,PD combined with PV/SMV resection and reconstruction are safe and feasible surgical procedures.The surgical reconstruction method was determined according to the location and length of the invaded vessels,and also there were no significant
作者
田雾
顾海涛
王莹
张航
孙红成
黄力
陈国庆
彭志海
钟林
Tian Wu;Gu Haitao;Wang Ying;Zhang Hang;Sun Hongcheng;Huang Li;Chen Guoqing;Peng Zhihai;Zhong Lin(Department of General Surgery,Orthopaedics Hospital of Guizhou Province,Guiyang 550002,China;Department of Hepatobiliary and Pancreatic Surgery,Shanghai First People′s Hospital,Shanghai 200080,China;Department of General Surgery,Xiang′an Affiliated Hospital of Xiamen University,Xiamen 361101,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2019年第1期18-22,共5页
Chinese Journal of General Surgery
基金
国家重点研发计划子项目--多模分子影像系统临床验证(2016YFC0104106).
关键词
胰腺肿瘤
胰十二指肠切除术
血管外科手术
预后
Pancreatic neoplasms
Pancreaticoduodenectomy
Vascular surgical procedures
Prognosis
