摘要
目的探讨结肠下区动脉入路联合门静脉系统血管切除异体血管置换在根治性胰十二指肠切除术治疗合并血管侵犯的胰腺癌的应用价值。方法采用回顾性描述性研究方法。收集2014年3月至2015年6月首都医科大学附属北京朝阳医院收治的13例合并门静脉、脾静脉或两者汇合部受累的胰腺癌患者的临床病理资料。在结肠下区先行探查肠系膜上动脉（SMA）判断肿瘤可切除后，完整切除SMA、腹腔干右侧包括受累血管在内的肿瘤及周围软组织，应用异体血管完成门静脉一脾静脉系统重建。观察指标：（1）手术情况。（2）术后情况。（3）随访情况。采用电话和门诊方式进行随访，了解患者生存及肿瘤复发转移情况。随访时间截至2016年4月。正态分布的计量资料采用孟±s表示。结果（1）手术情况：13例患者均顺利完成结肠下区动脉入路联合门静脉、脾静脉或汇合部切除异体血管置换的根治性胰十二指肠切除术，手术时间为（489~31）min，术中出血量为（407~96）mL，无术中及术后死亡。（2）术后情况：13例患者中，3例术后出现胰瘘（A级2例、B级1例），1例出现胃瘫，均经保守治疗后痊愈；无出血、腹腔感染、腹泻、门静脉系统重建后吻合口狭窄及血栓形成等并发症。术后中位住院时间为12d。术后病理学检查结果：13例患者中，高分化腺癌2例，中分化腺癌7例，低分化腺癌4例；3例血管切缘阴性，2例血管内膜被侵犯。8例血管外膜可见肿瘤细胞浸润。ⅠB期1例，ⅡA期2例，ⅡB期6例，Ⅲ期4例；术后切缘病理学检查淋巴结阴性率为11／13。（3）随访情况：13例患者术后随访10个月，患者均健康生存，无肿瘤复发、转移。结论结肠下区动脉入路联合门静脉与脾静脉切除异体血管置换的根治性胰十二指肠切除术治疗合并门静脉、脾静脉或两者汇合部受累的胰腺癌�
Objective To investigate the application value of artery approach in the lower colon region combined with portal vein （PV） resection and allograft vascular grafts in radical pancreaticoduodenectomy for pancreatic cancer combined with vascular invasion. Methods The retrospective descriptive study was conducted. The clinicopathological data of 13 patients with pancreatic cancer involving in PV, splenic vein or junction who were admitted to the Beijing Chao Yang Hospital of Capital Medical University from March 2014 to June 2015 were collected. The superior mesenteric artery （ SMA）, tumors and soft tissues （ including involved vessels） in the right of the celiac trunk were resected after exploring SMA and evaluating resectability of tumors. Patients underwent PV-splenic vein resection and reconstruction with allogenic vein. Observation indicators ： （ 1 ） surgical situations ; （2） postoperative situations; （3） follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis up to April 2016. Measurement data with normal distribution were represented as x＋s. Results （ 1 ） Surgical situations： 13 patients successfully underwent radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV, splenic vein resection and allograft vascular grafts. Operation time and volume of intraoperative blood loss were respectively （ 489 ± 31 ） minutes and （ 407 ± 96 ） mL, without intra- and post- operative deaths. （ 2 ） Postoperative situations： of 13 patients, 3 and 1 patients were respectively complicated with pancreatic fistula （2 in grade A and 1 in grade B） and gastroplegia, and cured by conservative treatment. There was no occurrence of bleeding, intraperitoneal infection, diarrhea, anastomotic stenosis and thrombus. The median duration of postoperative hospital stay was 12 days. Results of postoperative pathological examination： of 13 patients
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2017年第10期1061-1066,共6页
Chinese Journal of Digestive Surgery
基金
国家自然基金面上项目（81571554、81273270、81471590）
关键词
胰腺肿瘤
胰十二指肠切除术
动脉入路
血管置换
Pancreatic neoplasms
Pancreaticoduodenectomy
Artery approach
Vascular grafts
