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目的许多近、远端胆管癌及壶腹周围癌的病人因血管受侵犯而丧失手术切除机会,本研究为提高手术切除率,延长生存期,改善病人生活质量而设计。方法 1990年3月～1996年10月,作者对50例近端胆管癌切除术和47例壶腹周围癌胰十二指肠切除术中的19例浸润了门静脉的患者,分别采用联合门静脉长度1.0～1.5cm;门静脉与肠系膜上静脉及脾静脉汇合部切除5例,切除长度2.0～4.0cm,门静脉侧壁切除5例。均行对端吻合成功。结果 19例中,17例恢复顺利,随访4～29个月,平均14个月,四例生存时间超过一年。围手术期死亡2例(10.5%)。结论癌肿浸润门静脉主干不超过2cm,浸润门静脉及肠系膜上静脉汇合部不超过5cm,无远处转移,可联合门静脉切除并行对端吻合是可行的。
Objectives Many patients with proximal and distal bile duct cancer and periampullary cancer have lost surgical resection due to vascular invasion. This study was designed to improve the resection rate, prolong survival, and improve patient quality of life. METHODS: Between March 1990 and October 1996, the authors used joint portal vein lengths in 19 cases of invasive portal vein in 50 cases of proximal cholangiocarcinoma resection and 47 cases of periampullary pancreatoduodenectomy. 1.0 to 1.5 cm; 5 cases of portal vein and superior mesenteric vein and splenic vein confluent section resection, length of 2.0 to 4.0 cm, and 5 cases of portal vein resection. All the end-to-end anastomosis was successful. Results Of the 19 cases, 17 cases recovered smoothly, followed up for 4 to 29 months with an average of 14 months. Four patients survived for more than one year. Perioperative death occurred in 2 patients (10.5%). Conclusions Invasion of the portal vein does not exceed 2 cm, and the portal vein and mesenteric vein confluence does not exceed 5 cm. There is no distant metastasis. It is feasible to perform portal vein resection and parallel anastomosis.