【摘要】 目的探讨壶腹部周围癌施行胰十二指肠切除术（ＰＤＲ）过程中，如何减少术中大出血、提高手术切除率和预防胰瘘的发生。方法暴露门静脉和肠系膜上静脉，在胰钩状突切除胰腺时，采用边夹边切边缝扎的方法，使胰腺组织与门静脉、肠系膜上静脉之间的静脉短支得到良好缝扎。门静脉有浸润时，作门静脉部分切除后修补或门静脉端端吻合。行含肠系膜上静脉门静脉（ＳＭＰＶ）在内的ＰＤＲ。在胰肠对端吻合时，尽量使主胰管接近胰腺残端的中央，预防胰瘘发生。结果采用Ｍａｃｈａｄｏ法重建消化道２７例，无１例发生胰瘘和胆瘘。结论在ＰＤＲ过程中，防止术中大出血，根据门静脉是否有肿瘤浸润作相应的门静脉处理和Ｍａｃｈａｄｏ法重建消化道，能提高ＰＤＲ的切除率和提高患者的生存率和生活质量。更多还原

【Abstract】 PURPOSE To determine how to minimize hematorrhea during operation, the improvement of surgical resection rate and to prevent pancreatic fistula from occurring in the course of pancreatoduodenal resection (PDR) in the treatment of periampullar carcinoma.METHODS During the operation, the portal vein and superior mesenteric vein should be well exposed, and suturing and ligating while clamping and resecting should be done when resecting the pancreas at the uncinate process.Thus good suture and ligation of the short branch of the vein between the pancreatic tissue and the protal and superior mesenteric veins can be achieved. When the portal vein is infiltrated,repair or end to end anastomosis may be performed after partial resection of the portal vein. PDR involving the superior mesentericportal vein (SMPV) may improve the surgical resection rate among stage Ⅱ and Ⅲ patients. In pancreatojejunostomy, the main pancreatic duct should be close to the center of pancreatic stump as much as possible, which contributes to the prevention of injury of the pancreatic duct leading to pancreatic fistula.RESULTS Machado′s procedure in reconstruction of the digestive tract was carried out in 27 cases, and none of them developed pancreatic or biliary fistula.CONCLUSIONS In the course of PDR, the prevention of hematorrhea during operation, relevant managment of the portal vein with or without tumor infiltration and Machado′s reconstruction of the digestive tract may improve the rate of PDR and quality of life and survival rate of the patients.更多还原