肠系膜上静脉／门静脉切除在胰腺癌根治切除中的临床价值探讨

目的探讨在胰十二指肠切除术中，为达到根治切除目的，联合肠系膜上静肪/门静脉（SMV／PV）切除的临床价值。方法回顾性分析1999年1月-2005年12月间天津医科大学附属肿瘤医院118例胰腺癌行胰十二指肠切除术患者，其中21例联合了不同程度的SMV／PV的切除，对两组患者的临床病理特征、并发症发生率、围手术期死亡率及预后进行分析。结果两组间在手术并发症、围手术期死亡率及术后生存率上比较无统计学差异。血管切除组中，共有8例患者术后病理证实SMV／PV受累，预后较差。但与同期未切除受累血管、断端阳性患者相比，血管切除组预后好于癌残留组（P〈0．01）。结论对于胰头癌局部浸润SMV／PV，但无远处转移的患者，应积极行手术切除。胰腺癌联合SMV／PV切除可以有效提高手术切除率，但并未增加术后并发症及围手术期死亡率。联合SMV／PV切除对提高胰腺癌的根治率和生存率有重要的意义。

Pancreaticoduodenectomy with SMV/PV resection in pancreatic head carcinoma

Objective To determine whether portal vein resection is a contraindication for radical pancreatectomy in patients with pancreatic carcinoma. Methods From January 1999 to December 2005, 118 patients underwent radical resection. The 118 patients were divided into a SMV/PV resection group （ n = 21 ） and a SMV/PV resection group （ n = 97 ）. The clinico-pathological characteristics, morbidity, and mortality were statistically compared between the two groups. Results The mortality, the morbidity and the overall survival rate of the patients who required SMV/PV resection were not significantly different from those of the patients who underwent pancreatic resection without SMV/PV resection. The patients requiring SMV/PV resection had a worse prognosis than those without vascular resection but still survived longer than the patients who underwent R1 or R2 resection. Conclusions Pancreaticoduodenectomy combined with SMV/PV resection can be performed safely. This surgical procedure shows a promising survival rate and can be recommended; however, candidates for SMV/PR should be carefully selected.