同种异体静脉血管置换在T3期胰头癌扩大胰十二指肠切除术中应用

目的:探讨同种异体血管置换技术在联合静脉血管切除重建T3期胰头癌治疗中的安全性及应用价值。方法:回顾性分析98例伴有门静脉和(或)脾静脉侵犯的T3期胰头癌接受联合静脉血管切除重建的扩大胰十二指肠切除术患者的临床资料,其中49例使用同种异体血管重建为A组,行联合门静脉和(或)脾静脉切除同种异体血管重建的扩大胰十二指肠切除术;按年龄、性别等与A组匹配的其他重建方式49例为对照组(B组),实施其他方式重建的扩大胰十二指肠切除术。结果:手术时间A组较B组无明显延长;术中出血量A组较B组有所增多,但无统计学差异;A组门静脉和(或)脾静脉的R0切除率较B组有所增加;两组并发症发生率相似;A组术后1年、2年的总体生存率较B组有轻度的增加,无病生存率术后1年、术后2年均有所增加。结论:行同种异体血管置换重建的扩大胰十二指肠切除术治疗T3期胰头癌,不增加手术时间、术中出血量及术后并发症,且可提高R0切除率,延长患者生存时间,切实可行并且安全有效。

Application of Allogeneic Venous Vascular Replacement in Extended Pancreatoduodenectomy for T3 Stage Pancreatic Head Cancer

Objective To explore the safety and application value of allogeneic vascular replacement in the treatment of stage T3 pancreatic head cancer combined with venous resection and reconstruction. Methods The clinical data of 98 patients with stage T3 pancreatic head cancer with portal and/or splenic vein invasion who underwent extended pancreaticoduodenectomy combined with venous resection and reconstruction were retrospectively analyzed. Among them, 49 patients underwent extended pancreaticoduodenectomy combined with portal and/or splenic vein resection and allogeneic vascular reconstruction according to age and sex, as group A. Forty-nine patients, who matched with group A, received extended pancreaticoduodenectomy with other reconstruction methods as control group (group B). Results The operation time of group A was no longer than that of group B, and the amount of bleeding during operation in group A was larger than that in group B, but there was no statistical difference. The resection rate of portal vein and/or splenic vein in group A was higher than that in group B, and the incidence of complications was similar between the two groups. The overall survival rate of group A was slightly higher than that of group B, and the disease-free survival rate increased after 1 year and 2 years of operation. Conclusion Expanded pancreaticoduodenectomy with allogeneic vascular replacement and reconstruction for stage T3 pancreatic head cancer does not increase the operation time, intraoperative bleeding and postoperative complications, and can increase the resection rate of R0 and prolong the survival time of patients. It is feasible, safe and effective.