游离肠系膜上动脉在扩大胰十二指肠切除术治疗胰头钩突癌中的应用及其意义  

The role of full length superior mesenteric artery isolation in extended pancreaticoduodenectomy in the treatment of ductal adenocarcinoma of the pancreas in the uncinate process

作　　者：张怡杰[1] 胡先贵[1] 金钢[1] 邵成浩[1] 何天霖[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：《中华外科杂志》2009年第21期1627-1629,共3页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（30772139）

摘　　要：目的探讨提高累及肠系膜根部的胰头钩突癌手术切除的安全性和术后生存率的方法。方法2004年1月至2008年3月，第二军医大学附属长海医院普外科采用全程游离肠系膜上动脉（SMA）的方法，连续为26例胰头钩突导管腺癌患者施行以肠系膜根部切除为重点的扩大胰十二指肠切除术。其中男性16例，女性10例，年龄30～75岁，中位年龄（55．0±13．0）岁。11例施行部分门静脉和肠系膜上静脉联合切除。对所有手术切除标本进行病理学检查，并对患者进行跟踪随访。结果全组无手术死亡。所有术后标本手术切缘均为阴性。患者接受7～45个月随访，26例患者的疼痛症状得到了完全缓解，1年和2年累积生存率分别为72．2％和48．1％。结论在扩大胰十二指肠切除术治疗胰头钩突癌中采用全程游离SMA的方法，可以在一定程度上提高手术安全性和彻底性，并有益于术后生存率和生活质量的提高。Objective To improve the prognosis and safety of extended pancreaticoduodenectomy for patients with pancreatic cancer in the uncinate process of pancreas. Methods From January 2004 to March 2008,26 extended pancreaticoduodenectomies with full length superior mesenteric artery （SMA） isolation and mesentery root resection were performed for the ductal adenoearcinomas in the uncinate process of pancreas. There were 16 males and 10 females aging from 30 to 75 years old[ medium age （55.0 ±13.0） years old ]. Eleven of 26 patients were combined with portal vein-superior mesenteric vein resection. The effect and safety of this procedure were analyzed retrospectively. Results There was no operative mortality in all patients. The pathological examination showed that all the incisal margins were negative. After a follow-up of 7 to 45 months ,the pain relief was occurred in all patients. The 1-year,2-year accumulated survival rates were 72. 2% , and 48. 1% , respectively. Conclusions Full length SMA isolation and the mesentery resection in extended pancreaticodudenectomy are safe and effective. The procedure is also benefit for the patients in improving the survival rate and quality of life.

关 键 词：胰腺肿瘤 胰十二指肠切除术 肠系膜上动脉 存活率 

分 类 号：R686[医药卫生—骨科学]