选择性动静脉优先处理在根治性胰十二指肠切除术中的应用  

Selective “artery-or-vein first” approach in radical pancreaticoduodenectomy

作　　者：朱峰[1] 徐盟[1] 王敏[1] 秦仁义[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,武汉430030

出　　处：《中华普通外科学文献（电子版）》2012年第6期10-13,共4页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的探讨选择性动静脉优先处理在根治性胰十二指肠切除术中的应用。方法回顾性分析2011年4月至2012年6月116例胰、十二指肠恶性病变患者的临床资料,均采用选择性动静脉优先处理的根治性胰十二指肠切除术治疗。患者术前进行多排螺旋CT薄层扫描和三维血管重建检查,并精确评估肿瘤与邻近血管的关系及受累情况。结果平均手术时间为320(260～460)min,术中平均出血量380(200～600)ml;9例患者联合血管切除。无一例手术死亡,4例(3.45%)出现胰瘘,2例(1.72%)发生消化道大出血,3例(2.59%)发生胃肠排空障碍。结论选择性动静脉优先处理在根治性胰十二指肠切除术中可作为一种新型手术入路,它具有一定的优势,同时不增加并发症的发生率,但其在长期预后方面的优势有待进一步临床试验验证。Objective To investigate the application of selective ＂artery-or-vein first＂ approach in radical pancreaticoduodenectomy. Methods Between April 2011 and June 2012, 116 patients were given selective ＂artery-or-vein first＂ approach of radical pancreaticoduodenectomy for malignant tumor of pancreas or duodenum. The clinical data were retrospectively analyzed. All patients were pre-operatively muhidetector spiral CT examined and vessel reconstructed to precisely evaluate the vascular involvement and resectability status. Results The average operation time was 320 （ranged between 260 and 460） rain and the average blood loss was 380 ml （range between 200 and 600 ml）. Nine patients underwent venous resection followed by reconstruction. There were no operative deaths. The postoperative pancreatic fistula occurred in 4 patients （ 3.45% ）. Gastrointestinal bleeding occurred in 2 patients （ 1.72% ）. Delayed gastric emptying occurred in 3 patients（2.59%）. Conclusions The selective ＂artery-or-vein first＂ approach can serve as a novel approach in modem pancreatic surgery. It has certain advantages without increase of complication. However, further clinical study is still needed for long term prognosis.

关 键 词：胰腺肿瘤 胰十二指肠切除术 根治性 血管处理 

分 类 号：R735[医药卫生—肿瘤]