胰十二指肠联合门静脉切除治疗胰头癌

目的探讨胰头癌侵犯门静脉联合血管重建的适应证和方法。方法对2001年5月~2004年12月收治的8例肿瘤侵犯门静脉的胰头癌患者,行胰头十二指肠联合门静脉切除及门静脉对端吻合血管重建的手术资料进行回顾性分析。全组均行联合肠系膜上静脉-门静脉切除,门静脉阻断时间为22~35min;同时清扫腹膜后重要血管周围的淋巴组织。结果手术后8例患者均顺利恢复,无胆、胰瘘、感染及出血、血栓发生。病理检查切除肿瘤均为腺癌。切除血管内膜和胰腺边缘均无肿瘤浸润。随访时间6个月~4年,2例患者死于术后6~12个月。存活超过2年者4例。结论在门静脉-肠系膜上静脉侵犯小于3cm的选择性病例中施行联合切除血管的胰头癌根治术可提高其切除率,患者存活率有一定程度提高。

Combined pancreatoduodenectomy and vascular reconstruction in treatment of pancreatic head cancer

Objective To evaluate surgical indications and methods for regional pancreatoduodenectomy combined with blood vessel reconstruction. Method Eight patients underwent pancreatoduodenectomy combined with superior mesenteric vein and portal vein (SMV/PV) resection and reconstruction from May 2001 to December 2004,respectively. Results The overall mortality was 0 during perioperative period,no complications occurred. Histological specimen examinations demonstrated adenocarcinoma of pancreas head in all patients. The resected endothelium or margins of the blood vessel and pancreas were microscopically tumor free in all cases. Patients were followed-up from six months to four years.Two patients were died within one year. Four patients had survived for more than two years. Conclusion Regional pancreatoduodenectomy combined with blood vessel reconstruction could increase tumor resection rate in properly selected patients, and could be performed safely without increased morbidity and mortality.