同种异体血管移植在联合门静脉切除的胰腺癌根治术中的应用  

Use of allograft vessels for portal venous reconstruction during radical resection for pancreatic cancer

作　　者：王伟林[1] 叶松[1] 沈岩[1] 张珉[1] 严盛[1] 郑树森[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,杭州310003

出　　处：《中华普通外科杂志》2016年第5期365-369,共5页Chinese Journal of General Surgery

基　　金：浙江省科技厅重大科技专项重点社会发展项目（2014C03041.2）;浙江省医药卫生科技项目（201484382）

摘　　要：目的总结分析同种异体血管在联合门静脉切除的胰腺癌根治术中应用的临床要点及优势。方法回顾性分析我中心2009年6月至2013年5月收治的14例采用同种异体血管作为受累门静脉替代物进行植入重建的胰腺癌患者。分析胰腺癌行胰十二指肠切除（pancreaticoduodenectomy，PD）联合同种异体血管植入术的临床特征、病理特点以及围手术期并发症，死亡率等资料，用Kaplan．Meier法分析患者生存曲线。结果本组平均年龄（59．1±10．4）岁。肿瘤平均直径为（3．9±1．3）cm，切除血管的平均长度为（4．4±0．5）cm，R0切除率71．4％。其中4例植入血管为异体门静脉，10例植入血管为异体髂动脉；按植入血管的形态分“I”型血管植入9例，“Y”型血管植入5例。本组总体中位生存期为（14．0±3．0）个月，1、2年生存率为52．0％、40．0％。结论同种异体血管作为PD术中的门静脉替代物具有生物学、结构学的优势，“Y”型血管能够对一部分较复杂的门脉系统重建提供合适造型的替代物。Objective To explore the clinical-usage of allograft vessels for portal venous reconstruction during radical resection for pancreatic cancer. Methods We retrospectively analyzed clinical data of 14 patients who underwent pancreaticoduodenectomy with vascular resection （PDVR） and reconstruction by allograft vascular form June 2009 to May 2013. Results Patient＇s mean age was （59. 1±10.4） years old. The mean diameter of tumors was （3.9±1.3） cm, mean length of resected vessels was （4.4±0. 5 ）cm, and the R0 resection rate was 71.4%. The implanted vessels in 4 cases were allograft portal veins, and in the other 10 cases were allograft iliac arteries. In morphological classification, 9 cases used straight vessels and 5 cases used Y shaped vessels. The overall median survival time of the group was （14.0±3.0） months. The 1, 2 year＇ s survival rate was 52. 0% and 40. 0%, respectively. Conclusions Allograft vessels for portal venous reconstruction during PDVR have biological and structural advantages.

关 键 词：胰十二指肠切除术 血管移植术 门静脉切除重建 

分 类 号：R735.9[医药卫生—肿瘤]