游离肠系膜上动脉对提高胰腺钩突癌切除彻底性的临床意义  

Isolation of superior mesenteric artery and resection of mesentery root is beneficial for radicalpancreaticoduodenectomy in the treatment of pancreatic ductal adenocarcinoma

作　　者：张怡杰[1] 胡先贵[1] 金钢[1] 何天霖[1] 邵成浩[1] 李刚[1] 经纬[1] 宋彬[1] 

机构地区：[1]第二军医大学附属长海医院普外科,上海200433

出　　处：《中华胰腺病杂志》2008年第6期353-356,共4页Chinese Journal of Pancreatology

基　　金：国家自然科学基金（30772139）

摘　　要：目的观察游离肠系膜上动脉、切除肠系膜根部的扩大胰十二指肠切除术对累及肠系膜根部胰腺钩突癌的手术效果。方法2004年1月至2007年12月为23例（男14例，女9例，年龄30—72岁）累及肠系膜根部的胰腺钩突癌患者施行了合并游离肠系膜上动脉、切除肠系膜根部的扩大胰十二指肠切除术，对手术方法、手术安全性及手术疗效进行分析。结果12例患者施行了肠系膜根部切除的扩大胰十二指肠切除术，11例同时施行了肠系膜上静脉的切除和重建。平均手术时间（4．2±1．1）h，术中出血量（1635±1362）ml，术中输血量（1609±1462）ml。全组患者无手术死亡，6例出现轻至重度腹泻，术后住院天数9—30d。病理示，肿瘤直径3～8cm，合并淋巴结转移13例（57％），神经浸润20例（87％），22例手术切缘均为阴性，11例血管切除患者中有10例血管内膜浸润。随访5—42个月，4例发生肝转移，3例局部复发，1年、2年的累积生存率分别为77．2％和42．5％。结论通过游离肠系膜上动脉，对肠系膜根部组织、肠系膜上动脉周围神经以及广泛后腹膜组织的切除可以提高胰十二指肠切除术治疗胰腺钩突癌的手术彻底性，有效降低肿瘤残留，减少局部复发。手术方法是安全的。Objective To improve the prognosis and radical resection of the extended pancreatieoduodenectomy for patients with pancreatic cancer in the ucinate process involving mesentery root. Methods From Jan. 2004 to Dec. 2007, a total of 23 （ 14 male and 9 female, aged between 30 and 72 years old） patients with pancreatic cancer in the ucinate process involving mesentery root were treated in our department. Curative resection was performed for all patients by the extended pancreaticoduodenectomy with superior mesenteric artery （SMA） isolation and mesentery root resection. The surgical procedure, the safety and prognosis were analyzed retrospectively. Results 12 patients underwent the procedure, among them 11 also underwent combined SMV partial resection and reconstruction. The operation time was （4.2 ± 1.1 ） hours, and the blood loss was （ 1 635 ± 1 362） ml with the blood transfusion of （ 1 609 ± 1 462） ml. There was no operation related death in this case series, and mild to severe diarrhea occurred in 6 cases. The postoperative stay ranged 9 to 30 days. The pathological examination showed that the tumor size was （5.3 ± 1.4 ） cm. 13 patients （57%） had one or more lymph nodes metastasis. 20 patients （87%） had nerve involvement. Among 11 patients with SMV partial resection and reconstruction, 10 patients had endangium involvement. 22patients had negative surgical margins for all specimens. Rapid intra-operative frozen pathological examination showed negative surgical margins in one patient, however, post-operative paraffin section pathological examination revealed nerve involvement between SMA and celiac trunk. After a follow-up of 5 to 42 months, liver metastasis occurred in 4 patients, and local recurrence occurred in 3 patients. The 1-year and 2-year accumulated survival rates were 77.2% and 42.5%, respectively. Conclusions Isolation SMA and the mesentery resection in extended pancreaticodudenectomy were safe and useful. Using this modified technique, Redical operation resection coul

关 键 词：胰腺肿瘤 胰十二指肠切除术 肠系膜上动脉 

分 类 号：R735.9[医药卫生—肿瘤]