联合血管切除重建在胰腺癌根治术中的安全性及价值  

Value and safety of the surgery with vascular resection and reconstruction for pancreatic cancer

作　　者：黄斌[1] 陆才德[2] 裘丰[2] 吴胜东[2] 华永飞[2] 周新华[2] 虞伟明[2] 黄静[2] 

机构地区：[1]宁波大学医学院,315041 [2]宁波市医疗中心李惠利医院肝胆胰外科

出　　处：《中华外科杂志》2016年第1期56-62,共7页Chinese Journal of Surgery

摘　　要：目的探讨联合血管切除在胰腺癌根治术中的安全性及价值。方法收集2009年1月至2014年3月宁波市医疗中心李惠利医院接受胰腺癌根治切除术并符合纳入标准的206例患者病例资料进行回顾性分析，按有无联合血管切除分成无血管切除组132例，联合门静脉和肠系膜上静脉（SMV）组66例，联合动脉切除组8例。比较分析3组患者的术前和手术资料，重点分析联合血管切除对术后并发症和生存状况的影响。随访截至2014年9月。结果206例患者中行胰十二指肠切除术137例，胰体尾切除术44例，全胰十二指肠切除术25例；192例获得随访，14例分别于术后5～8个月失访，随访率为93．2％，中位随访时间29个月（5～63个月）。无血管切除组、联合门静脉和SMV切除组、联合动脉切除组手术时间分别为（347±96）、（425±91）、（508±120）min，组间两两比较差异均有统计学意义（P值均〈0．05）；手术出血量[M（QR）]分别为500（400）、800（500）、1750（2075）ml，组间两两比较差异均有统计学意义（P值均〈0．01）。无血管切除组、联合门静脉和SMV切除组术后并发症发生率分别为16．7％（22／132）、28．8％（19／66），联合动脉切除组中6例发生并发症，组间两两比较差异均有统计学意义（P值均〈0．05）。无血管切除组、联合门静脉和SMV切除组、联合动脉切除组中位生存时间分别为15、15、12个月，两两比较差异无统计学意义（P值均〉0．05）。术后3组患者病死率均为零。结论联合静脉切除术后并发症发生率略高于无血管切除患者，但对术后生存无影响。对胰腺癌合并动脉侵犯患者应严格掌握指征，如能达根治切除有一定价值。Objective To investigate the value and safety of the surgery with vascular resection and reconstruction during pancreatectomy for pancreatic cancer. Methods The clinical data of 206 patients with pancreatic cancer who underwent radical resection were retrospectively analyzed from January 2009 to March 2014 in Lihuili Hospital,Medical center of Ningbo. All cases were divided into non-vascular resection group（ 132 cases）, the combined vein resection group （66 cases） and the combined arterial resection group （8 cases） . The peri-operation data, the incidence of postoperative complications and the survival were compared in pairs among three groups. All patients were followed up till September 2014. Results There were no statistical differences for the preoperative data among three groups. The operation time and the blood loss （ M（ QR ） ） were （ 347 ± 96 ） minutes and （ 500 （ 400 ） ） ml in non-vascular resection group, （ 425 ± 91）minutes and （800 （500）） ml in combined vein resection group, （508± 120 ） minutes and （ 1 750 （2 075 ） ）ml in combined arterial resection group, with significant differences among three groups （all P 〈 0. 01 ）. The incidence of postoperative complication was 16.7% （ 22/132 ） in non-vascular resection group,28. 8% （19/66） in combined vein resection group,and 6 cases in combined arterial resection group, respectively. There were significant differences between non-vascular resection group and combined vein resection group（ P 〈 0.05 ）, non-vascular resection group and combined arterial resection group（ P 〈 0. 05 ）, as well as between combined vein resection group and combined arterial resection group （ P 〈 0. 05 ）. Themedian survival time was 15 months for non-vascular resection group, 15 months for combined vein resection group, and 12 months for combined arterial resection group. No significant difference was found among three groups （ all P 〉 0. 05）. The postoperative mortality was nil for all of g

关 键 词：胰腺肿瘤 联合静脉切除重建 联合动脉切除重建 手术后并发症 预后 

分 类 号：R735.9[医药卫生—肿瘤]