侵犯重要血管的胰头癌切除的可行性探讨  

The feasibility of surgical resection for carcinoma of the head of pancreas with major vascular invasion

作　　者：刘颖斌[1] 马孝明[1] 李江涛[1] 王许安[1] 蔡炜龙[1] 孔颖[1] 王俊[1] 王建伟[1] 曹利平[1] 彭淑牖[1] 

机构地区：[1]浙江大学医学院附属第二医院外科,浙江杭州310009

出　　处：《外科理论与实践》2007年第3期221-224,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:总结5年来所见侵犯重要血管的胰头癌诊治经验。方法:对2002～2006年间收治的61例侵犯重要血管的胰头癌的临床资料进行回顾性分析。结果:本组61例中,侵犯门静脉11例,侵犯肠系膜上血管13例,联合侵犯门静脉、肠系膜上血管12例,侵犯其他血管但无广泛转移者共13例,广泛转移者12例。61例病人中行B超检查的58例,CT检查42例,行MRCP18例,ERCP15例。20例行单纯胰十二指肠切除术,4例联合血管切除的胰十二指肠切除术,2例行联合血管切除的全胰切除术,其余行Roux-en-Y胆肠内引流术。全组无手术死亡。结论:对侵犯重要血管的胰头癌,B超可用于筛查,而CT结合MRCP/ERCP对于确定肿瘤的病变范围、血管浸润等有较高价值。对于满足适应证的病例,应积极采用联合血管切除的胰十二指肠切除术;对于不适合者,可行胆肠内引流,以改善病人生活质量和延长生存时间。Objective To summarize the experiences of diagnosis and surgical treatment of carcinoma of the head of pancreas with major vascular invasion. Methods The clinical data of 61 patients admitted from 2002 to 2006 were analyzed retrospectively. Results Of the whole series, 11 cases involved invasion of the portal vein（PV）, 13 involved invasion of the superior mesenteric vessels, 12 with simultaneous PV and superior mesenteric vessels involvement, 13 with involvement of other important vessels, and the other 12 with diffused dissemination. The number of patients submitted to ultrasonic examination, CT, MRCP and ERCP was 58, 42,18 and 13, respectively. Twenty patients underwent pancreatoduodenectomy, 4 underwent pancreato-duodenectomy with vascular resection, and 2 were submitted to total pancreatic resection with simultaneous vascular resection; Roux-en-Y hepaticojejunostomy was performed to the rest. No perioperative mortality occurred. Conclusions Ultrasonic examination is useful for screening the cases of carcinoma of the head of pancreas with important vascular invasion. ERCP, CT and MRCP may help to determine the tumor size and the status of vascular invasion. Pancreatoduodenectomy plus vascular resection is performed for appropriately chosen cases. Roux-en-Y hepaticojejunostomy is performed for non-resectable cases to prolong survival time and improve the quality of life.

关 键 词：胰腺肿瘤 外科手术 血管 肿瘤侵犯 

分 类 号：R735.9[医药卫生—肿瘤]