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目的 探讨联合血管重建胰十二指肠切除术的适应证和方法。方法 回顾自 1994年 4月至 2 0 0 1年3月多家协作医院 42例联合血管重建胰十二指肠切除术的经验。 42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。全组均联合肠系膜上静脉门静脉 (SMVPV)切除 ,其中合并肠系膜上动脉 (SMA)和肝动脉 (HA)切除重建者分别为 4例和 2例。 1例胰头癌因与下腔静脉前壁粘连紧密不能分开则合并下腔静脉前壁部分切除修复。结果 围手术期死亡 3例 (7 1% )。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均无肿瘤浸润。失访 2例。随访时间 3～ 87个月 ,7例死于术后 7个月至 3年 ,其中 6例为合并SMA、HA切除重建者 ,存活超过 3年 19例 ,超过 5年 6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其切除率 ,延长病人存活时间
Objective To explore the indications and methods of combined revascularization for pancreatoduodenectomy. Methods From April 1994 to March 2001, a series of collaborative hospitals in 42 cases of combined revascularization of pancreaticoduodenectomy experience. Forty-two patients underwent pancreatoduodenectomy, of which 1 had pancreatic head cancer involving the colon and hepatic debridement and the right colon resection. All patients underwent combined superior mesenteric vein portal vein (SMVPV) resection, including 4 cases and 2 cases with reconstruction of superior mesenteric artery (SMA) and hepatic artery (HA). One case of pancreatic cancer due to adhesions with the inferior vena cava anterior wall can not be separated closely combined partial anterior inferior wall vena cava resection and repair. Results Perioperative death in 3 cases (71%). No biliary pancreatic fistula and vascular complications of artificial infection. Pathological examination results: 1 case of pancreatic neuroendocrine malignancy, the rest were adenocarcinoma, resection of the intima and pancreatic resection margin tumor infiltration. Lost in 2 cases. The follow-up time ranged from 3 months to 87 months. Seven patients died from 7 months to 3 years after surgery. Six of them were SMA and HA resection and reconstruction recipients. Survival was more than 3 years in 19 cases and more than 5 years in 6 cases. The remaining cases are still under investigation. Conclusions Radical resection of pancreatic cancer of the pancreas in combination with resection of the blood vessels can improve the resection rate and prolong the survival time