侵犯动脉的胰腺癌外科治疗新选择:动脉鞘剥除技术  

A novel surgical option for artery-involving pancreatic cancer: sub-adventitial divestment technique

作　　者：苗毅 蔡宝宝[1] 陆子鹏 Miao Yi;Cai Baobao;Lu Zipeng(Pancreas Center,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Pancreas Center,BenQ Medical Center,Nanjing Medical University,Nanjing 210019,China)

机构地区：[1]南京医科大学第一附属医院胰腺中心,南京210029 [2]南京医科大学附属明基医院胰腺中心,南京210019

出　　处：《中华消化外科杂志》2022年第4期456-460,共5页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81672449, 82173206);江苏省强卫工程医学杰出人才项目(JCRCA 2016009);江苏省重大疾病生物资源样本库项目(BM2015004);江苏省医学重点学科(ZDXKA2016005)。

摘　　要：根治性切除是改善胰腺癌患者预后的关键, 合并动脉侵犯是局部进展期胰腺癌不可切除的主要原因。对于累及动脉的胰腺癌进行更精准的可切除性评估, 选择适宜的外科技术, 有赖于对肿瘤侵犯动脉解剖学、组织学以及肿瘤生物学的进一步深入理解。传统基于累及动脉周径的肿瘤影像学评估不等于真实意义上的病理学侵犯。在可切除性评估中, 动脉被侵犯的深度比受累及的周径更重要。对动脉结构的形态学观察发现:动脉外弹力层是否受侵犯决定动脉鞘剥除的可行性与联合动脉切除的必要性。动脉鞘剥除技术为合并动脉侵犯的胰腺癌患者提供根治性切除机会, 同时可避免动脉切除重建的高死亡率与并发症发生率。对肿瘤侵犯深度和生物学行为更精准地评估将为侵犯动脉局部进展期胰腺癌的外科决策提供更可靠的依据。Radical resection remains as the key treatment to improve the prognosis of pancreatic cancer,and arterial invasion hinders radical resection for locally advanced lesions.More accurate assessment of resectability and selection of appropriate surgical techniques depend on better understanding of the anatomy,histology,and tumor biology of pancreatic cancer invasion to the artery.Traditional radiology assessment for artery involvement,based on the circumference of involved arteries,is not equivalent to pathological artery invasion.The depth of arterial invasion is more important than the circumference in evaluating resectability.Results of morphological observa-tion on arterial structure shows that both the feasibility of sub-adventitial divestment technique(SDT)and the necessity of arterial resection depend on whether the external elastic lamina of artery is invaded.The SDT can provide an opportunity for radical resection for pancreatic cancer with arterial invasion,while avoiding the high mortality and incidence of complications caused by arterial resection.A more precise assessment of tumor invasion depth and biological behavior will provide a more reliable basis for surgical decision for the treatment of locally advanced pancreatic cancer with arterial invasion.

关 键 词：胰腺肿瘤 局部进展期 可切除性评估 动脉鞘剥除技术 联合动脉切除 

分 类 号：R735.9[医药卫生—肿瘤]