【摘要】 目的探讨联合血管切除的胰十二指肠切除术的必要性、手术适应证和手术操作中必须注意的问题。方法回顾性分析我院2002年1月至2005年1月行联合血管切除的胰十二指肠病人43例(A组),并与同期未行联合血管切除的96例病人(B组)在术中、术后各方面进行比较。结果A组中单独PV或SMV节段切除者为8和16例,楔形切除分别为3和4例,同时切除PV／SMV者9例,联合PV／SMV／SMA／HA切除者3例;A组病理示肿瘤侵犯血管全层共6例(13．95％);A、B两组在术时、术中输血量及术后并发症、淋巴结阳性率方面差异均无显著性。结论对术前检查未发现PV／SMV内有癌栓或闭塞、肿瘤未包埋SMA或腹腔干根部的病人,行联合血管切除的胰十二指肠切除术是必要的,但须严格掌握手术适应证且术中解剖仔细、操作细致,以期提高手术的安全性和成功率。更多还原

【Abstract】 Objective To discuss the necessity, indications and noticeable problems of pancreatoduodenectomy in combination with vascular resection. Methods The clinical data of 43 patients (group A) receiving pancreatoduodenectomy in combination with vascular resection and those of 96 (group B) undergoing pancreatoduodenectomy without vascular resection in our hospital from January 2002 to January 2005 were retrospectively analyzed and compared. Results In group A, 8 patients were treated with portal vein (PV) resection, 16 with superior mesentery vein (SMV) resection, 3 with cuneiform resection in PV, 4 with cuneiform resection in SMV, 9 with resection of PV and SMV and 3 with resection of PV, SMV, SMA and HA. Six of the 43 patients (13. 95%) had invasion of the whole blood strata by the cancer. There were no differences between group A and B in operative duration, blood transfusion in operation, surgical complications and positive lymph node rates. Conclusions It is necessary to perform the pancreatoduodenectomy in combination with vascular resection if there are cancerous blots and occlusion in PV or SMV and the superior mesenteric artery and radical celiac aorta are not buried by the cancer. Careful selection of surgical indications and operation are important for improving the surgical security and successful rate.更多还原