联合血管重建胰十二指肠切除治疗胰头恶性肿瘤

目的: 探讨提高联合血管重建胰十二指肠切除率和方法.方法: 回顾总结1994年4月至2004年5月间多家医院79例联合血管重建胰十二指肠切除术的临床资料.本组79例行胰十二指肠切除,其中1例胰头癌累及结肠肝曲合并右半结肠切除.全组联合肠系膜上静脉(SMV)-门静脉(PV)切除,其中合并肠系膜上动脉(SMA)和肝动脉(HA)一同切除重建4例,合并SMA或HA切除重建分别为7例和4例.2例胰头癌因与下腔静脉(IVC)前壁粘紧不能分开则合并下腔静脉前壁部分切除修复.结果: 本组病例围手术期死亡4例(5%).无胆胰瘘及人工血管感染并发症.病理检查结果:胰腺神经内分泌恶性肿瘤1例,其余均为腺癌,切除血管内膜和胰腺切缘经病理检查均无肿瘤浸润.本组失访2例.随访时间3~120个月,9例死于术后7个月~4年,其中7例为合并SMA或HA切除重建者.存活超过3年者37例,超过5年者11例.其余病例尚在随访中.结论: 在选择适宜的病例中施行联合切除血管的胰头癌根治术可提高肿瘤切除率,延长患者存活时间,手术安全.

Vascular reconstruction combimed pancreatoduodenectomy to treat the malignant tumor at the caput pancreatis

Objective:To evaluate surgical resection rate and methods of pancreatoduodenectomy combined with vascular reconstruction.Methods:The clinical data of pancreatoduodenectomies with vascular reconstruction were reviewed and summarized in 79 patients at a number of co-operating hospitals between April 1994 and May 2004. Seventy-nine patients were undergone. One of them involved the pancreatic head and the hepatic flexure of colon. Pancreatoduodenectomy combined with right hemicolectomy was performed on them. Superior mesenteric vein(SMV)-portal vein (PV) resection were performed in all cases. Superior mesenteric artery(SMA) and hepatic artery(HA) reconstructions were performed in 4 of them,and SMA or HA reconstructions were carried out in 7 and 4 other cases,respectively. Partial inferior vena cava(IVC) reconstruction was done in 2 cases as the tumor adhered to the anterior wall of the IVC.Results:Four patients died during the peri-operative period,giving a mortality rate of 5%. No complications,such as biliary or pancreatic fistulae or artificial blood vessel infections were experienced. Histological specimen examinations identified one case as neuroendocrine cancer and the other 78 cases as adenocarcinoma of the pancreatic head. Resected tunica intima and cut margins of the pancreas were proved to be microscopically without infiltration. According to follow-up records for all but two of the patients,follow-up periods between 3 months and 10 years. In 9 patients,7 of whom had undergone SMA and HA resection and reconstruction,died within 7 months to 4 years after operations,37 cases survived for over 3 years and 11 cases for more than 5 years. The rest are still under follow-up visits.Conclusion:Pancreatoduodenectomy with vascular reconstruction for carefully selected patients with carcinoma of the pancreatic heads is proved to be a safe and reliable treatment,being capable of raising tumor resection rate and prolonging opportunity of survival.