联合门静脉/肠系膜上静脉切除的胰十二指肠术治疗胰头癌的疗效

目的:分析联合门静脉(PV)/肠系膜上静脉(SMV)切除的胰十二指肠切除术(PD)治疗胰头癌的临床疗效。方法:回顾性分析2010年1月—2013年7月手术治疗的72例胰头癌患者的临床及术后随访资料,其中40例肿瘤未累及肝总动脉、SMV、PV也无转移的患者行单纯PD术(PD组),32例单纯性累及PV/SVM的患者行联合PV/SMV切除的PD术(PV/SMV组),比较两组患者的围手术期指标及术后情况。结果:与PD组比较,PV/SMV组的手术时间(357.4min vs.289.3min)、术中出血量(851.2m L vs.641.5m L)均明显增加(均P0.05),但输血量(700.0m L vs.650.5m L),手术并发症发生率(18.75%vs.20.00%),1、2、3年生存率(50.00%vs.57.50%、31.25%vs.37.50%、21.86%vs.25.00%)以及中位生存时间(15个月vs.18个月)差异均无统计学意义(均P0.05)。结论:对于胰头癌患者应根据患者的实际情况选择适宜的手术方式,联合PV/SMV切除的PD治疗单纯性累及PV/SVM的胰头癌临床效果可靠,术后远期预后与PD手术适应证者相当。

Efficacy of pancreaticoduodenectomy combined with portal vein/superior mesenteric vein resection for pancreatic head cancer

Objective: To evaluate the clinical efficacy of pancreaticoduodenectomy (PD) combined portal vein (PV) andsuperior mesenteric vein (SMV) resection in treatment of cancer in the head of the pancreas.Methods: The clinical and postoperative follow-up data of 72 patients with cancer in the head of the pancreasundergoing surgical treatment from January 2010 to July 2013 were retrospectively analyzed. Of the patients,40 cases without involvement of common hepatic artery, SMV or PV and without metastasis underwent simplepancreatoduodenectomy (PD group), and 32 cases having simple PV/SMV involvement underwent PD combined with PV/SMV resection (PV/SMV group). The perioperative variables and postoperative conditionsbetween the two groups of patients were compared.Results: In PV/SMV group compared with PD group, the operative time (357.4 min vs. 289.3 min), andintraoperative blood loss (851.2 mL vs. 641.5 mL) were significantly increased (both P<0.05), while the volumeof blood transfusion (700.0 mL vs. 650.5 mL), incidence of surgical complications (18.75% vs. 20.00%), and 1-,2- and 3-year survival rate (50.00% vs. 57.50%, 31.25% vs. 37.50% and 21.86% vs. 25.00%) as well as the mediansurvival time (15 months vs.18 months) showed no statistical difference (all P>0.05).Conclusion: For pancreatic head cancer, the appropriate surgical approach should be chosen based on the actualsituation of the patients. PD with synchronous PV/SMV resection has reliable efficacy in treatment of pancreatichead cancer with simple PV/SVM involvement, with similar long-term postoperative results as those in patientswith surgical indications for PD.