全胰十二指肠切除术治疗胰腺癌手术要点及术后康复管理情况  

Analysis of surgical key points and postoperative rehabilitation management of total pancreaticoduodenectomy for pancreatic cancer

作　　者：刘喆 贾亚男 罗云昭 吕少诚[1] 许文犁 朱继巧[1] 郎韧[1] 贺强[1] 李先亮[1] Liu Zhe;Jia Yanan;Luo Yunzhao;Lyu Shaocheng;Xu Wenli;Zhu Jiqiao;Lang Ren;He Qiang;Li Xianliang(Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院肝胆胰脾外科,北京100020

出　　处：《中华肝胆外科杂志》2024年第3期188-192,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨血管切除技术时代,全胰十二指肠切除术的手术安全要点及术后快速康复情况。方法回顾性分析2014年11月至2022年9月在首都医科大学附属北京朝阳医院行全胰十二指肠切除术的52例胰腺癌患者的临床病理资料,其中男性34例,女性18例,年龄(62±9)岁。分析患者的术中情况、术后并发症发生率、术后血糖控制情况及术后生存情况。结果52例患者均顺利完成手术,其中48例为动脉入路联合门静脉、肠系膜上静脉切除重建的全胰十二指肠切除术,术中门静脉阻断时间为(20±5)min。术后并发症发生率为28.8%(15/52),其中胃排空异常2例,腹泻2例,乳糜瘘2例,腹腔感染4例,胃肠瘘1例,消化道出血3例,肺部感染1例。术后早期采用皮下注射短效胰岛素方式控制血糖,恢复饮食后采用短效联合长效胰岛素皮下注射,未出现难以控制的高血糖。52例随访患者中位生存期为13个月,最长随访时间为38个月,42例死亡患者中37例死于肿瘤复发,4例死于心脑血管意外,1例死于肺部感染。结论对侵犯血管的胰腺癌患者行动脉优先入路的全胰十二指肠切除术能提高R0切除率,其术后并发症发生率及死亡率并无明显增加,术后血糖控制满意,生活质量得到保证。Objective To explore the safety key points of total pancreaticoduodenectomy in the era of vascular resection technology and the important factors affecting rapid postoperative recovery.Methods The clinical data of 52 patients with pancreatic cancer who underwent total pancreaticoduodenectomy in Beijing Chaoyang Hospital Affiliated to Capital Medical University from November 2014 to September 2022 were retrospectively analyzed,including 34 males and 18 females,aged(62±9).The intraoperative situation,incidence of postoperative complication,postoperative blood glucose control and postoperative survival rate were analyzed.Results All operations of the 52 patients were successfully completed,including 48 patients underwent total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts via artery approach.The portal vein occlusion time was(20±5)min.The incidence of postoperative complications was 28.8%(15/52),including 2 cases of abnormal gastric empty,2 cases of diarrhea,2 cases of chylous fistula,4 cases of abdominal infection,1 case of gastrointestinal fistula,3 cases of gastrointestinal bleeding,and 1 case of pulmonary infection.Subcutaneous short-acting insulin injection was used to control blood glucose in the early stage after surgery,short-acting insulin combined with long-acting insulin was used for subcutaneous injection before sleep for diet recovery.All patients did not experience uncontrolled hyperglycemia.The median survival time of 52 patients was 13 months,and the longest follow-up time was 38 months.There were 37 patients died of tumor recurrence,4 patients died of cardiovascular and cerebrovascular accidents,and 1 patient died of pulmonary infection in the 42 died patients.Conclusions Total pancreaticoduodenectomy via artery approach can improve the R0 resection rate in pancreatic cancer patients with vascular invasion,the rate of postoperative complication and mortality has no significant increase.The postoperative blood sugar control is satisfactory and the quality

关 键 词：胰腺肿瘤 全胰十二指肠切除术 动脉入路 血管置换 

分 类 号：R735.9[医药卫生—肿瘤]