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目的 为胰腺癌区域化疗选择合理的动脉途径提供理论依据。方法 胰腺癌开腹后探查不能切除的病例39例,男20例,女19例。年龄45-66岁,分为五组,Ⅰ组:腹腔干组,由胃左动脉插管进入腹腔干5例;Ⅱ组;胃十二指肠组,24例;其中ⅡA组9例,由胃网膜右动脉插管进入胃十二指肠动脉,ⅡB组15例,插管直接进入胃十二指肠动脉;Ⅲ组:胃网膜右动脉组,直接插入该动脉,5例;Ⅳ组:脾动脉组,进行脾动脉逆行插管,5例。结果 注入亚甲基蓝5min腹腔干组可见胃大弯近贲门处染色;ⅡA组见胃大弯染色自幽门至胃网膜左右交界处,大网膜/十二指肠起始部、降部及胰头部明显染色;脾动脉组见胰尾染色。注入亚甲基蓝30分钟后腹腔干组见胰头及十二指肠起始部及降部淡染;ⅡB组见一例体部染色,另外14例染色范围无改变;脾初组无明显改变。结论 胰头癌以胃十二指肠动脉为首选,可根据情况选择直接插管或经胃网膜右动脉进入该动脉。胰体尾癌应通过脾动脉插管化疗。
Objective To provide a theoretical basis for the selection of reasonable arterial approaches for regional chemotherapy of pancreatic cancer. Methods Thirty-nine cases of unresectable pancreatic cancer were explored. There were 20 males and 19 females. Age 45-66 years old, divided into five groups, group I: abdominal celiac group, from the left gastric artery into the peritoneal cavity in 5 cases; Group II; gastroduodenal group, 24 cases; including IIA group in 9 cases, The right gastroepiploic artery was cannulated into the gastroduodenal artery, in the IIB group, 15 cases, and the cannula directly into the gastroduodenal artery; Group III: the right gastroepiploic artery group, directly inserted into the artery, 5 cases; IV Group: Spleen artery group, retrograde intubation of splenic artery, 5 cases. The results of injection into the methylene blue 5min celiac trunk group can be seen near the gastric cardia of the greater curvature of the cardia; IIA group see large curvature of the stomach stained from the pylorus to the right junction of the gastric retina, omentum / duodenum, descending and pancreatic head Department of staining; spleen artery group see pancreatic tail staining. After 30 minutes of injection of methylene blue, the pancreatic head and the duodenum at the beginning and in the lower part of the coeliac stem group were lightly stained; in the IIB group, one body staining was seen, and in the other 14 cases, the staining range was unchanged; there was no significant change in the early spleen group. Conclusion Gastric duodenal artery is the first choice for pancreatic head cancer. It can be directly intubated or enter the artery through the right gastroepiploic artery according to the situation. Pancreatic body and tail cancer should be intubated with chemotherapy via the splenic artery.