49例胰腺癌血管浸润的术前评估与手术切除方法探讨  

Preoperative evaluation of blood vessel infiltration of pancreatic carcinoma and technique for its resection

作　　者：王春友[1] 熊炯昕[1] 周峰[1] 吕平[1] 陈立波[1] 范骥[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺外科中心,武汉市430022

出　　处：《中华肝胆外科杂志》2003年第11期661-663,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 对进展期胰腺癌血管浸润的程度、范围进行影像学评估及手术切除可行性判断并探讨其切除方法。方法 对经术前CT和MR/MRCP检查伴血管浸润的49例进展期胰腺癌进行影像学分析,根据临床及影像学特征确定手术指征,同时根据术中发现确定对受累血管的处理和手术方法。结果 49例伴血管浸润的进展期胰腺癌中,影像学评估无手术指征者6例,其余43例接受手术探查的病例中,施行肿瘤手术切除30例,切除率为69.8％,其中行血管切除者25例。结论 现代影像学技术有助于评估进展期胰腺癌血管浸润程度,对指导手术切除和术中受累血管处理方法有重要意义,改进手术方法有助于提高伴血管浸润的进展期胰腺癌的手术切除率。Objective To evaluate the degree and scope of blood vessel infiltration in progressive pancreatic carcinoma with imaging methods and explore the technique for its resection. Methods In order to determine the indications of laparotomy, 49 cases of advanced pancreatic carcinoma with blood vessel infiltration were preoperatively examined by CT and MR/MRCP/MRA. The principle of management was decided according to the preoperative evaluation. The operative approach was selected according to findings during the operation. Results Of the 49 cases of advanced pancreatic carcinoma with blood vessel infiltration, 6 had no indication of laparotomy. Laparotomy was performed in the left 43 cases. Amongst these 43 patients, 30 (69. 8%) received resection of the tumor. Blood vessel resection was conducted in 25 cases. Conclusions CT and MR/MRCP/MRA are useful for evaluation of blood vessel infiltration in advanced pancreatic carcinoma because they can provide important evidence for operation decision-making and the management of involved blood vessels. Modified Whipple approach can improve the resectability of advanced pancreatic carcinoma with blood vessel infiltration.

关 键 词：胰腺癌 血管浸润 术前评估 手术切除 手术方法 影像学检查 

分 类 号：R735.9[医药卫生—肿瘤] R730.56[医药卫生—临床医学]