全动脉优先离断法在Ⅱ型胰头癌根治性切除中的应用价值  

Application value of "total arterial devascularization first" in radical resection of type Ⅱ pancreatic head carcinoma

作　　者：王敏[1] 朱峰[1] 田锐[1] 石程剑[1] 彭丰[1] 徐盟[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：《中华肝脏外科手术学电子杂志》2014年第6期8-11,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金面上项目(81272659);国家自然科学基金青年基金(81101621)

摘　　要：目的探讨全动脉优先离断法（TADF）在Ⅱ型胰头癌根治性切除中的应用价值。方法回顾性分析2012年5月至2014年1月在华中科技大学同济医学院附属同济医院采用TADF行根治性胰头十二指肠切除术的86例Ⅱ型胰头癌患者临床资料。其中男51例，女35例；年龄42～78岁，中位年龄65岁。所有患者均签署知情同意书，符合医学伦理学规定。所有患者胰腺血管的处理均采用TADF，预置肠系膜上静脉（SMV）/门静脉（PV）及肠系膜上动脉（SMA）阻断带，切断胰颈部，沿SMA前方、右侧和后方，完全离断胰头部与SMA、腹腔动脉干之间的血管、神经结缔组织；剥离或切除、重建SMV/PV，从而整块切除肿瘤。观察患者围手术期情况，包括手术完成情况、手术方式、术中出血量、术后并发症发生情况。结果86例患者均顺利完成根治性胰头十二指肠切除术，手术时间为4.6～8.3 h，术中出血量为200～600 ml。SMV血管侧壁切除修补26例，SMV血管切除端端吻合12例。围手术期无死亡患者。患者术后出血、胰瘘发生率分别为6%（5/86）、8%（7/86）。结论Ⅱ型胰头癌采用TADF行根治性切除术能保障手术安全性，减少术中出血量，并可提高其总体切除率和根治性切除率，降低SMV/PV的误切率。ObjectiveTo evaluate the application value of ＂total arterial devascularization first＂ （TADF） in radical resection of typeⅡ pancreatic head carcinoma.MethodsClinical data of 86 patients with typeⅡ pancreatic head carcinoma undergoing radical pancreatoduodenectomy by TADF in Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from May 2012 to January 2014 were analyzed retrospectively. There were 51 males and 35 females with the age ranging from 42 to 78 years and median age of 65 years. The informed consents of all patients were obtained and the ethical committee approval was received. The pancreatic vessels in all the patients were treated by TADF. Occluding bands of the superior mesenteric vein （SMV）/portal vein （PV） and superior mesenteric artery （SMA） were preset. Pancreatic neck was cut off. Along the anterior, right, posterior surfaces of SMA, vessels and neural connective tissues between pancreatic head and SMA, celiac aorta were totally dissected and cut off. The involved SMV/PV were stripped or resected, and reconstructed. Then the en-bloc tumor was removed. The perioperative situation was observed including operative completion, surgical procedures, intraoperative blood loss and postoperative complications.ResultsRadical pancreatoduodenectomy was performed successfully in all 86 cases. The operation duration was 4.6-8.3 h, intraoperative blood loss was 200-600 ml. The operation included SMV sidewall resection and repair （n=26）, SMV resection and end to end anastomosis （n=12）. No death case was observed during the perioperative period. The incidences of postoperative hemorrhage, pancreatic ifstula were 6% （5/86）, 8% （7/86） respectively.ConclusionsApplying TADF in radical resection of typeⅡ pancreatic head carcinoma can ensure the safety of operation, reduce the intraoperative blood loss, improve the general and radical resection rates, and decrease the SMV/PV accidental cutting rate.

关 键 词：胰腺肿瘤 胰头癌分型 胰十二指肠切除术 全动脉优先离断术 术后并发症 

分 类 号：R735.9[医药卫生—肿瘤]