改良式Appleby手术治疗晚期胰体尾癌

目的: 介绍一种治疗胰体尾癌侵袭肝总动脉、脾动脉及腹腔干的改良式Appleby手术方法 。方法: 腹腔干自起始部接扎切断,将肿瘤及侵袭的动脉整块切除。术中注意保留网膜右和胃右动脉,以维持胃的血供。夹闭肝总动脉后,注意肝固有动脉的搏动情况 。结果: 术后,上腹部及腰背部疼痛消失,七个月后患者死于肝脏及肝门部转移,经影像学检查未见切除部位肿瘤复发 。结论: 该术式可提高胰体尾癌的手术切除率与根治程度,可改善病人术后的生存质量。

Modified Appleby operation for carcinoma of the body and tail of the pancreas

Objective:To share our experience on the treatment of a patient with advanced carcinoma of the body and tail of the pancreas invading the common hepatic,splenic and celiac arteries with modified Appleby operation.Methods:The celiac artery was ligated at its start point,and distal pancreas and involved arteries were resected en bloc. Pyloric and right gastroepiploic arteries were retained to keep blood supply to the stomach,and pulsation of the proper hepatic artery could be felt after occlusion of the common hepatic artery.Results:The patient was relieved from epigastric and back pain after the operation,although he died of liver metastasis seven months later. CT scan did not show local reoccurrence before her death. Conclusion:This procedure can increase the resectability and radical extent of locally advanced cancer of the body and tail of the pancreas and offer patients a better quality of life.