胰腺癌扩大切除与血管重建中值得进一步关注的问题  

Further concerns on extended radical resection of pancreatic cancer and vascular reconstruction

作　　者：郑树森[1] 严盛[1] 张启逸[1] 孙飞[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,浙江杭州310003

出　　处：《中国实用外科杂志》2013年第9期723-726,共4页Chinese Journal of Practical Surgery

摘　　要：随着围手术期管理水平的提高,胰腺癌扩大根治术的安全性获得了有效改善,是现阶段提高胰腺癌病人存活率的重要手段。术前3D-CT重建对血管变异和肿瘤侵犯程度的评估直接影响手术的成功。当胰腺癌侵犯静脉时,门静脉-肠系膜上静脉的切除重建已成为常规,并根据切除长度决定是否行血管移植、脾静脉结扎或重建。根据外科医生经验,选择自体血管、人造血管或同种异体血管进行移植。当肿瘤侵犯腹腔干、肝动脉、肠系膜上动脉时,行动脉切除重建手术风险大,技术难度高,要求显微外科技术支持,如能手术成功,有望使晚期胰腺癌病人延长生存期。With the improvement of perioperative management, it has been safer to perform extended radical resection of pancreatic cancer （PC）, which has become the only hope to improve the survival rate of PC patients. Pre-operative assessment using 3-dimensional CT reconstruction of the vascular variation and the extent of tumor invasion directly affect the success of surgery. It has become a routine procedure of excision and reconstruction of the portal vein or superior mesenteric vein when it had been involved. Whether graft implantation, splenic vein ligation or reconstruction depends on the length of resected vessel. Graft choice of autologous, synthetic or allogenic vessels varies with individual surgeons. When celiac artery, hepatic artery or superior mesenteric artery were involved by PC, it is high risky to perform artery resection and reconstruction. Support of expert microsurgical technique would help to make the complex pancreatic resection a safer procedure, so that patients with advanced pancreatic cancer is expected to get long-term survival.

关 键 词：胰腺癌 扩大切除 血管重建 门静脉 肠系膜上 动脉 

分 类 号：R6[医药卫生—外科学]