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目的:分析联合门静脉(PV)/肠系膜上静脉(SMV)切除的胰十二指肠切除术(PD)治疗胰头癌的临床疗效。方法:回顾性分析2010年1月—2013年7月手术治疗的72例胰头癌患者的临床及术后随访资料,其中40例肿瘤未累及肝总动脉、SMV、PV也无转移的患者行单纯PD术(PD组),32例单纯性累及PV/SVM的患者行联合PV/SMV切除的PD术(PV/SMV组),比较两组患者的围手术期指标及术后情况。结果:与PD组比较,PV/SMV组的手术时间(357.4min vs.289.3min)、术中出血量(851.2m L vs.641.5m L)均明显增加(均P<0.05),但输血量(700.0m L vs.650.5m L),手术并发症发生率(18.75%vs.20.00%),1、2、3年生存率(50.00%vs.57.50%、31.25%vs.37.50%、21.86%vs.25.00%)以及中位生存时间(15个月vs.18个月)差异均无统计学意义(均P>0.05)。结论:对于胰头癌患者应根据患者的实际情况选择适宜的手术方式,联合PV/SMV切除的PD治疗单纯性累及PV/SVM的胰头癌临床效果可靠,术后远期预后与PD手术适应证者相当。
Objective: To analyze the clinical effect of pancreaticoduodenectomy (PD) combined with portal vein (PV) / superior mesenteric vein (SMV) resection. Methods: The clinical and postoperative follow-up data of 72 patients with pancreatic head cancer who underwent surgical treatment from January 2010 to July 2013 were retrospectively analyzed. Among them, 40 patients had no involvement of hepatic artery, SMV and PV without metastasis PD patients (PV group) and PD patients (PV / SMV group) who underwent PV / SMV resection alone were treated with simple PD (PD group) and 32 patients with simple PV / SVM. Perioperative indexes and postoperative conditions were compared between the two groups. Results: Compared with PD group, the operation time (357.4min vs.289.3min) and intraoperative blood loss (851.2m L vs. 641.5m L) in PV / SMV group were significantly increased (all P <0.05) (700.0m L vs.650.5m L), the incidence of complications (18.75% vs.20.00%), 1, 2, 3 years survival rate (50.00% vs.57.50%, 31.25% vs.37.50%, 21.86% vs.25.00%, respectively) and median survival time (15 months vs.18 months) (all P> 0.05). CONCLUSIONS: Patients with pancreatic head cancer should be given appropriate surgical procedures according to the actual situation of the patients. Combined with PV / SMV resection of PD, the clinical effect of pancreatic head cancer with simple PV / SVM involvement is reliable. The long-term postoperative prognosis and PD surgical adaptation The same is true.