先行门-肠系膜上静脉重建的扩大胰十二指肠切除术  

Extended pancreatico-duodenectomy with prior porto-superior mesenteric vein shunting

作　　者：胡先贵[1] 金钢[1] 张怡杰[1] 刘瑞[1] 邵成浩[1] 唐岩[1] 

机构地区：[1]第二军医大学附属长海医院肝胆胰外科,上海200433

出　　处：《外科理论与实践》2007年第3期218-220,共3页Journal of Surgery Concepts & Practice

摘　　要：目的:为使一些原本由于体积较大或侵犯门静脉而无法安全切除的胰头部肿瘤病人得到手术治疗的机会,我们尝试施行先行门-肠系膜上静脉重建的胰十二指肠切除术。方法:2004年9月～2005年6月,对5例严重侵犯肠系膜上静脉或门静脉的胰头部肿瘤病人施行先行人造血管门-肠系膜上静脉重建的扩大胰十二指肠切除术。平均年龄61岁。肿瘤平均直径4.8cm。结果:5例病人均成功施行先行门-肠系膜上静脉重建的胰十二指肠切除术,无手术死亡及严重并发症发生。平均手术时间260min,平均术中出血1570ml,平均术后住院天数18天。术后随访,平均术后生存时间为11.6个月(4～15月)。结论:由于先行建立了通畅的门静脉系统血流,有效地保证了肝脏的主要血流,减少了严重肠道淤血和肝脏缺血的发生。本术式在切除肿瘤前,即在原位完成门脉的阻断与重建,理论上能够降低手术过程中对肿瘤的挤压而导致肿瘤细胞门静脉系统播散的可能性。Objective To explore the efficacy and safety of extended pancreatico-duodenectomy with prior porto （PV）-superior mesenteric vein （SMV） shunting, in the resection of large pancreatic head cancer or cases with PV involvement, Methods Between September 2004 and June 2005, 5 cases of pancreatic cancer with PV or SMV involvement underwent this pre-shunting operation by using ringed Gore-Tex vascular graft, The mean age of the patients was 61 years and the average diameter of the tumors was 4,8 em, Results Extended pancreatico-duodenectomy with prior PV-SMV shunting was successfully performed in all these 5 patients, without operative mortality and severe complications. The mean operative time was 260 min and the average length of postoperative hospitalization was 18 days. The average volume of intraoperative blood transfusion was 1 570 ml. The mean postoperative survival time was 11.6 months （4-15 months）. Conclusions With prior shunting of PV to SMV by using vascular graft, mesenteric venous blood can be sent to PV without interruption, thus preventing any visceral congestion or hepatic ischemia, In addition, this procedure might help to prevent cancer cell dissemination during surgical manoeuvring.

关 键 词：胰腺肿瘤 胰头十二指肠切除术 方法 

分 类 号：R735.9[医药卫生—肿瘤]