胰十二指肠切除术联合血管切除重建的应用及疗效

目的探讨胰十二指肠切除联合血管切除重建术的围手术期治疗策略及临床疗效。 方法回顾性分析2010年1月至2016年2月在中山大学附属第一医院行胰十二指肠切除术的患者363例，其中胰十二指肠切除联合血管切除重建术38例，设为联合组；标准胰十二指肠切除术325例，设为标准组。对比两组患者手术时间、出血量、术后住院天数、术后胰瘘发生率、腹腔出血或消化道出血发生率、腹腔感染发生率、胆瘘发生率及围手术期病死率。 结果联合组及标准组的手术时间分别为（7.5±2.2）h和（5.9±1.7）h，术中出血量中位数分别为500（100~4 500）ml、200（20~12 000）ml。联合组的手术时间延长、出血量增加，差异有统计学意义（t=-5.153，P<0.001；Z=-4.028，P<0.001）。联合组的术后住院天数为（20.3±14.2）d，标准组为（18.5±13.1）d，两组比较差异无统计学意义（t=-0.811，P=0.418）。联合组的并发症发生率、病死率分别为26.3%（10/38）、2.6%（1/38），标准组分别为35.4%（115/325）、1.8%（6/326），两组比较差异均无统计学意义（P=0.266、0.539）。联合组术后血管病理证实15例有癌细胞侵犯，35例移植血管通畅，3例发生门静脉血栓并发症。 结论与单纯胰十二指肠切除术相比，胰十二指肠切除联合血管切除重建手术并不增加患者术后住院时间、围手术期并发症发生率及病死率，对于伴有血管侵犯的肿瘤患者有可能获益。

Application and effect evaluation of pancreaticoduodenectomy combined with vascular resection and reconstruction

ObjectiveTo investigate the perioperative risk and effect evaluation of pancreatico- duodenectomy (PD) with vascular resection and reconstruction. MethodsA retrospective analysis was carried out on three hundred and sixty-three patients who had undergone PD from January 2010 to February 2016 in the First Affiliated Hospital of Sun Yat-sen University. The combination group included 38 cases underwent PD and treated with vascular resection and reconstruction, and the control group included 325 cases just undergoing PD. The differences in operative time, blood loss, postoperative hospital stay, rate of post-PD pancreatic fistula, rate of intra-abdominal or alimentary tract hemorrhage, rate of biliary fistula and perioperative mortality rate were compared between the two groups. ResultsAll cases were successfully completed. The operative time in the combination group was significantly longer than control group [(7.5±2.2) h vs (5.9±1.7) h, t=-5.153, P<0.001]. The median intraoperative blood loss in combination group was 500 (100-4 500) ml, which was more than 200 (20-12 000) ml of control group (Z=-4.028, P<0.001). The combination group had no advantage in the postoperative hospital stay [(20.3±14.2) d vs (18.5±13.1) d, t=-0.811, P>0.05]. The incidence of complication and mortality in the combination group were 26.3% (10/38) and 2.6% (1/38), while 35.4% (115/325) and 1.8% (6/326) in the control group, with no significant differences between two groups (P=0.266, 0.539). Postoperative vascular pathology in the combination group confirmed that 15 patients were invaded by cancer cells, 35 of graft patency, and 3 of portal vein thrombosis complications. ConclusionCompared with normal PD, PD combined with vascular resection and reconstruction does not increase postoperative hospital stay, perioperative complication rate and mortality, and may help patients with vascular invasion.