联合血管切除重建的胰十二指肠切除术疗效分析  

Efficacy of pancreaticoduodenectomy combined with vascular resection and reconstruction

作　　者：孙家乾[1] 张朝斌[2] 张雷达[2] 陈耿[2] 别平[2] 王槐志[2] 

机构地区：[1]山东大学附属临沂市人民医院普通外科七科,276003 [2]第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院,重庆400038

出　　处：《中华消化外科杂志》2011年第5期344-346,共3页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81072439）

摘　　要：目的探讨联合血管切除重建的胰十二指肠切除术的临床疗效。方法回顾性分析2007年1月至2011年5月第三军医大学西南医院收治的56例术前诊断为胰腺肿瘤行联合血管切除重建的胰十二指肠切除术患者的临床资料，统计患者围手术期并发症发生率、病死率及术后生存情况。结果本组患者平均手术时间为473min（234～853min），术中平均输血量为781ml（0—900m1），其中7例患者未输血；中位住院时间为25．9d（17—100d）；43例患者进行了人工血管重建。56例患者围手术期并发症发生率为34％（19／56），病死率为7％（4／56）。术后病理诊断：胰头导管腺癌42例，壶腹部癌5例，胆管下端癌3例，十二指肠乳头癌4例，胰头神经内分泌癌1例，胰腺浆液性囊腺瘤1例。随访截至2011年8月，患者1年生存率为57％（32／56），平均生存时间为13．5个月。32例生存患者体质量均不同程度增加，无腹痛。术后3个月内5例患者有轻度腹泻，需要服用止泻药；1例患者术后1个月发现人造血管内血栓形成、中等量腹腔积液，半年后侧支循环形成，腹腔积液消失。结论对于伴有血管侵犯的胰腺肿瘤患者，应积极行联合血管切除重建的胰十二指肠切除术，能改善胰腺癌晚期患者的生命质量。Objective To investigate the efficacy of pancreaticoduodenectomy （PD） combined with vascular resection and reconstruction. Methods The clinical data of 56 patients who received PD combined with vascular resection and reconstruction at the Southwest Hospital of Third Military Medical University from January 2007 to May 2011 were retrospectively analyzed. The incidence of perioperative complications, mortality and post- operative conditions were also analyzed. Results The mean operation time and intraoperative blood transfusion were 473 minutes （range, 234-853 minutes） and 781 ml （range, 0-900 ml）, respectively. Seven patients did not receive blood transfusion. The median period of hospital stay was 25.9 days （range, 17-100 days）. A total of 43 patients underwent PD combined with vascular reconstruction. The incidence of perioperative complications and mortality rate were 34% （19/56） and 7% （4/56）, respectively. There were 42 patients with pancreatic ductal adenocarcinoma, 5 with ampullary carcinoma, 3 with distal bile duct carcinoma, 4 with papillary carcinoma of duodenum, 1 with pancreatic neuroendocrine carcinoma and 1 with pancreatic serous cystadenoma. All patients were followed up till August 2011, and the 1-year survival rate was 57% （32/56）. The mean survival time was 13.5 months. The weight of 32 surviving patients increased and no abdominal pain occurred. Within 3 months after the operation, 5 patients had slight diarrhea and were administered antidiarrheal; thrombosis in the artificial blood vessels and peritoneal effusion were found in 1 patient, while 6 months later, collateral circulation was formed and the peritoneal effusion was diminished. Conclusion PD combined with vascular resection and reconstruction can improve the quality of life for patients with pancreatic cancer and with blood vessels involvement.

关 键 词：胰腺肿瘤 胰十二指肠切除术 血管重建 并发症 生存率 

分 类 号：R735.9[医药卫生—肿瘤]