结肠下区动脉入路联合门静脉肠系膜上静脉切除治疗胰头癌的临床观察研究  

Clinical Study on Inferior Infracolic “Superior Mesenteric Artery First” Approach with Superior Mesenteric-portal Vein Resection in Patients with Pancreatic Head Cancer

作　　者：杨世伟[1] 石军[1] 项灿宏[1] 曾建平[1] 韩东冬[1] YANG Shi-wei;SHI Jun;XIANG Can-hong(Department of Hepato-Biliary-Pancreatic Surgery,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing(102218),China)

机构地区：[1]清华大学附属北京清华长庚医院肝胆胰外科清华大学临床医学院

出　　处：《中国中西医结合外科杂志》2019年第6期925-929,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：北京市医管局扬帆计划基金资助（ZYLX201712）

摘　　要：目的:探讨结肠下区动脉入路联合门静脉肠系膜上静脉切除治疗胰头癌的应用价值。方法:采用回顾性描述性研究方法。收集2015年6月至2018年3月清华大学附属北京清华长庚医院收治的胰头癌患者的临床病理资料。分三组包括常规入路的手术方式联合门静脉肠系膜上静脉(SMPV)切除(15例),结肠下区动脉入路方式无SMPV切除(19例),以及结肠下区动脉入路方式联合SMPV切除(16例),比较手术中情况,术后情况以及随访情况。采用电话和门诊方式进行随访,了解患者生存率。结果:所有患者均顺利完成手术,没有围手术期死亡。常规入路组手术时间(381.33±39.39)min较动脉入路组(436.32±37.09)min和复杂手术组(458.44±45.05)min缩短;动脉入路组术中出血量(452.63±97.97)mL较常规入路组(610.00±139.28)mL和复杂手术组(578.13±111.76)mL明显减少;常规入路组顽固性腹泻(0例)较动脉入路组(5例)和复杂手术组(4例)明显降低(P<0.05);其余并发症和病理结果比较无明显差异;常规入路组中位生存时间19月,动脉入路组为24月,复杂手术组为23月,三组间比较没有差异。结论:结肠下区动脉入路联合门静脉肠系膜上静脉切除是安全可行的,可以作为胰头癌的手术治疗首选术式。Objective To investigate the application value of inferior infracolic“Superior Mesenteric Artery First”approach with superior mesenteric-portal vein resection in patients with the pancreatic head cancer.Methods The retrospective descriptive study was conducted.The clinicopathological data of patients with pancreatic head cancer admitted to Beijing Tsinghua Changgung Hospital from June 2015 to March 2018 were collected.The patients were divided into three groups,namely,routine operation with superior mesentericportal vein resection(SMPVR group,n=15),the inferior infracolic“Superior Mesenteric Artery First”approach with(AFA+SMPVR group,n=16)or without(AFA group,n=19)superior mesenteric-portal vein resection.The operational factors,postoperative factors,and the follow-up were compared.The follow-up was carried out by telephone and outpatient to understand the survival rate of patients.Results All patients successfully underwent the radical pancreaticoduodenectomy without perioperative death.The operative time of the SMPVR group was less than that of AFA+SMPVR group and AFA group while the blood loss of the AFA group was less than those in the other two groups,(P<0.05).No severe diarrhea occurred in the SMPVR group.The comparison of the rest complications and clinicopathological data was negative.The median survival time was 19 months,24 months and 23 months in the SMPVR group,AFA group and AFA+SMPVR group,respectively.Conclusion The inferior infracolic“Superior Mesenteric Artery First”approach with superior mesenteric-portal vein resection in patients with pancreatic head cancer is safe and feasible, which could be used as a first option.

关 键 词：胰头癌 动脉入路 门静脉肠系膜上静脉切除 生存率 

分 类 号：R735.9[医药卫生—肿瘤]