联合血管切除重建的胰十二指肠切除术治疗胰头癌  

Pancreaticoduodenectomy combined with vascular resection and reconstruction for pancreatic head carcinoma

作　　者：陈曦[1] 王槐志[1] 张雷达[1] 

机构地区：[1]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》2015年第9期761-765,共5页Chinese Journal of Digestive Surgery

基　　金：基金项目：卫生公益性行业科研专项（201202007）

摘　　要：目的探讨联合血管切除重建的胰十二指肠切除术在胰头癌治疗中的临床应用价值。方法回顾性分析2014年3月第三军医大学西南医院收治的1例行联合血管切除重建的胰十二指肠切除术胰头癌患者的临床资料。术前影像学检查结果示胰头部占位性病变与门静脉血管壁无间隙，门静脉、脾静脉、肠系膜上静脉交汇处血管受压、狭窄，不能排除邻近门静脉主干受侵犯。术中胰头部上缘肿瘤与门静脉难以分离，考虑肿瘤侵犯门静脉、脾静脉、肠系膜上静脉交汇处血管壁。遂行胰头、胆管、十二指肠、部分空肠、侵犯的静脉血管和淋巴、神经组织的整块切除，及门静脉、肠系膜上静脉、脾静脉的重建。术后采用门诊和电话方式进行随访，随访时间截至2015年4月。结果患者顺利完成联合血管切除重建的胰十二指肠切除术，手术时间为285min，术中出血量为300mL，未输血，患者术中生命体征平稳。术后患者恢复顺利，术后第5天恢复进食，第6天拔除腹腔引流管，第12天拆线，第15天痊愈出院。术后复查腹部CT示血管吻合口通畅。无胰瘘、胆瘘、腹腔出血以及血管栓塞等严重并发症发生。术后病理学检查结果：胰头部中分化腺癌伴门静脉侵犯和淋巴结转移，切缘阴性。患者术后40d开始接受吉西他滨单药常规化疗1个疗程。术后随访1年，患者生命质量良好，无肿瘤复发征象。结论联合血管切除重建的胰十二指肠切除术治疗胰头癌安全可行，手术效果好。Objective To investigate the clinical application value of pancreatoduodenectomy combined with vascular resection and reconstruction for pancreatic head carcinoma. Methods The clinical data of a patient with pancreatic head carcinoma who underwent pancreatoduodenectomy combined with vascular resection and reconstruction at the Southwest Hospital in March 2014 were retrospectively analyzed. Preoperative imaging examination showed no gap between vascular wall of portal vein （PV） and pancreatic head space-occupying lesion, vascular compression and stenosis at intersection of PV, splenic vein （SV） and superior mesenterie vein （SMV） , but not excluding adjacent main PV invasion. During the operation, it was difficult to separate pancreatic head carcinoma from PV, indicating vascular wall invasion at intersection of PV, SV and SMV. Therefore, the pancreatic head, bile duets, duodenum, partial jejunum, invasive vein vessels, lymphatic and nerve tissues were radically resected, then PV, SMV and SV were reconstructed. The patient was followed up by outpatient examina- tion and telephone interview after surgery till April 2015. Results The patient underwent pancreatoduodenectomy combined with vascular resection and reconstruction successfully without blood transfusion. The operation time was 285 minutes and volume of intraoperative blood loss was 300 mL. The patient had a smooth postoperative recovery, resuming diet at postoperative day 5. The abdominal drainage tube and stitches were removed at postoperative day 6 and day 12, and the patient was discharged from hospital at postoperative day 15. Computed tomography reexa- mination showed clear vascular anastomose. The patient was not complicated with pancreatic fistula, biliary fistula, intra-abdominal hemorrhage and vascular embolism. The postoperative pathological examination confirmed the diagnosis of pancreatic head moderately differentiated adenocarcinoma accompanied by PV invasion and lymph node metastasis, with a negative margin. The patient began a cour

关 键 词：胰腺肿瘤 胰十二指肠切除术 肠系膜上静脉 门静脉 

分 类 号：R735.9[医药卫生—肿瘤]