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目的:探讨侵犯血管的胰腺癌根治手术中联合血管切除重建的可行性、手术适应证和术中注意事项。方法:回顾性分析2014年3月—2015年12月收治的12例行根治手术的胰腺癌并侵犯门静脉(PV)/肠系膜上静脉(SMV)患者资料,其中胰十二指肠切除术10例,联合PV除者3例、SMV节段切除者1例、PV/SMV同时切除6例,脾静脉均予结扎未重建,5例保留脾脏,1例因脾脏淤血严重行联合脾脏切除;胰体尾部切除术2例,均联合PV/SMV切除,同时行脾脏切除。门静脉阻断时间为16~30 min;血管对端吻合10例,人造血管移植2例。结果:12例患者术后均恢复顺利,无围手术期死亡,无胆瘘、胰瘘、出血、血栓、人工血管感染、肝功能衰竭等并发症发生,无近期区域性门静脉高压表现。结论:在有条件的医院选择合适的病例施行联合血管切除的胰十二指肠切除术或胰体尾切除术是可行的,可提高切除率,改善患者生存质量,并不增加手术死亡率和并发症发生率。但要求术中仔细解剖、细致操作,且达到肉眼根治性切除,以提高手术安全性和远期生存率。
Objective: To investigate the feasibility, surgical indications and intraoperative precautions of combined revascularization in the radical operation of invasive pancreatic cancer. Methods: The clinical data of 12 patients undergoing radical surgery and invasive portal vein (PV) / superior mesenteric vein (SMV) in 12 patients who were treated from March 2014 to December 2015 were retrospectively analyzed. Among them, 10 patients underwent pancreatoduodenectomy , 3 cases combined with PV, 1 case with SMV segmentectomy, 6 cases with PV / SMV resection at the same time, 5 cases with spleen preserved, 1 case with severe splenic congestion combined with splenectomy, Tail resection in 2 cases, both combined with PV / SMV resection, while splenectomy. Portal vein occlusion time was 16 ~ 30 min; vascular anastomosis in 10 cases, artificial vascular graft in 2 cases. Results: All the 12 patients recovered smoothly without any perioperative death. No complications such as biliary fistula, pancreatic fistula, hemorrhage, thrombus, artificial blood vessel infection and liver failure occurred. No regional portal hypertension was observed. Conclusion: It is feasible to choose the appropriate case in conditional hospital for pancreatoduodenectomy or pancreaticoduodenectomy, which can improve the resection rate and improve the quality of life of patients without increasing the mortality rate and Complication rate. However, surgery requires careful anatomy, meticulous operation, and to the naked eye radical resection, in order to improve surgical safety and long-term survival.