胰十二指肠切除术门静脉-肠系膜上静脉切除重建时围静脉阻断期管理策略分析  

Portal vein-superior mesenteric vein resection and reconstruction during pancreaticoduodenectomy using the perivenous occlusion management strategy

作　　者：王劭宏[1] 李竹鑫 国士刚 宁纯民 李傲雷 孔新亮 王向涛 李尚胜 柯山[1] 高君[1] 孔健[1] 李强 孙文兵[1] Wang Shaohong;Li Zhuxin;Guo Shigang;Ning Chunmin;Li Aolei;Kong Xinliang;Wang Xiangtao;Li Shangsheng;Ke Shan;Gao Jun;Kong Jian;Li Qiang;Sun Wenbing(Department of Hepatobiliary Pancreas and Spleen Surgery,West Campus,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100043,China;Department of General Surgery,Chaoyang Central Hospital,Chaoyang 122000,Liaoning Province,China;Department of Hepatobiliary and Pancreaticosplenic Surgery,the Second Hospital of Chaoyang,Chaoyang 122000,Liaoning Province,China;Department of Hepatobiliary and Pancreaticosplenic Surgery,Rizhao Central Hospital,Rizhao 276800,Shandong Province,China;Department of Hepatobiliary Surgery,the Second People's Hospital of Binzhou,Binzhou 256800,Shandong Province,China)

机构地区：[1]首都医科大学附属北京朝阳医院西院肝胆胰脾外科,北京100043 [2]朝阳市中心医院普外科,辽宁朝阳122000 [3]朝阳市第二医院肝胆胰脾外科,辽宁朝阳122000 [4]日照市中心医院肝胆胰脾外科,山东日照276800 [5]滨州市第二人民医院肝胆外科,山东滨州256800

出　　处：《中华肝胆外科杂志》2021年第5期362-366,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：北京市石景山区医学重点学科建设项目(20130001)。

摘　　要：目的探讨胰十二指肠切除术(PD)门静脉-肠系膜上静脉(PSMV)切除重建时围静脉阻断期管理策略及其影响。方法回顾性分析2010年1月至2020年12月在首都医科大学附属北京朝阳医院西院、朝阳市中心医院、朝阳市第二医院、日照市中心医院及滨州市第二人民医院行PD的137例胰腺癌患者资料,其中男性83例,女性54例,平均年龄61.8岁。将联合PSMV切除重建的42例纳入血管重建组(采用围静脉阻断期管理策略),无血管侵犯的95例纳入对照组。比较两组手术时间、术中出血量、术后住院时间、再次手术及围手术期死亡率以及术后并发症等。结果137例患者PD均顺利完成。血管重建组PSMV阻断时间15~120 min,中位数30 min。血管重建组手术时间380(330,465)min、术中出血量725(500,1000)ml、术后住院时间21.0(16.0,28.0)d,均高于对照组305(280,340)min、400(300,500)ml、18.0(14.0,24.5)d,差异有统计学意义(均P<0.05)。血管重建组再手术率4.8%(2/42)、围手术期死亡率2.4%(1/42),对照组分别为2.1%(2/95)、1.0%(1/95),两组比较差异无统计学意义(均P>0.05)。血管重建组胰瘘、腹腔积液及感染、肺部感染发生率高于对照组,差异有统计学意义(P<0.05)。两组术后出血、胃排空延迟、胆瘘、切口感染等比较,差异无统计学意义(P>0.05)。结论PSMV切除重建可明显增加PD术后胰瘘、腹腔积液及感染等并发症发生率,科学系统的围静脉阻断期管理策略对于促进术后顺利恢复,降低围手术期死亡率具有重要意义。Objective To explore the perivenous blocking management strategy for portal vein-superior mesenteric vein(PSMV)resection and reconstruction and its effect on postoperative complications in patients undergoing pancreaticoduodenectomy(PD).Methods The data of 137 patients with pancreatic cancer treated with PD in Beijing Chaoyang Hospital Affiliated to Capital Medical University,Chaoyang Central Hospital,the Second Hospital of Chaoyang,Rizhao Central Hospital,the Second People's Hospital of Binzhou from January 2010 to December 2020 were collected.There were 83 males and 54 females with an average age of 61.8 years.There were 42 patients in the reconstruction group and 95 patients in the control group.The main intraoperative indexes and postoperative complications were compared between the two groups with the aim to review our experience in PSMV resection and reconstruction by using the perivenous blocking management strategy.Results PD was successfully completed in 137 patients in the reconstruction group,the PSMV blocking time was 15-120 min,with a median of 30 min.The operation time 380(330,465)min,intraoperative blood loss 725(500,1000)ml,and postoperative hospital stay 21.0(16.0,28.0)d in the reconstruction group were significantly higher than those of control group[305(280,340)min,400(300,500)ml and 18.0(14.0,24.5)d](all P<0.05).The reoperation rate and perioperative mortality were 4.8%(2/42)and 2.4%(1/42)in the reconstruction group,while 2.1%(2/95)and 1.0%(1/95)in the control group,respectively.There was no significant difference between the two groups(both P>0.05).The incidence of pancreatic fistula,peritoneal effusion and infection,pulmonary infection of the reconstruction group was significantly higher than those of the control group(P<0.05).There was no significant difference in the incidence of postoperative bleeding,delayed gastric emptying,biliary fistula,incision infection,reoperation between the two groups(P>0.05).Conclusions PSMV resection and reconstruction significantly increased the incidences of

关 键 词：胰十二指肠切除术 静脉切除 静脉重建 液体管理 

分 类 号：R657.5[医药卫生—外科学]