与大血管粘连的胰头部肿块型胰腺炎行Whipple术(附3例报告)  

WHIPPLE OPERATIONS PERFORMED ON 3 CASES OF CHRONIC LUMP PANCREATITIS IN THE HEAD OF THE PANCREAS ADHERED WITH NEARBY VESSELS(A REPORT OF 3 CASES)

作　　者：孙振华[1] 张建国[1] 徐筠茹[1] 秦华东[1] 果永海[1] 赵文生[2] 王喜[2] 

机构地区：[1]哈尔滨医科大学附属第二医院普外科,黑龙江哈尔滨150086 [2]牡丹江烨林集团职工医院外科,黑龙江牡丹江157032

出　　处：《中国现代普通外科进展》2000年第2期40-41,54,共3页Chinese Journal of Current Advances in General Surgery

摘　　要：目的 探讨联合血管阻断下分离胰与门静脉和肠系膜上静脉(SMV)间炎性致密粘连的可行性和安全性.方法 采用依次阻断胰下的SMV.胰后的脾动静脉和胰上的门静脉方法,分高胰头部肿块型胰腺炎与门静脉和SMV间存在的手指难以分开的粘连3例.结果 分离粘连过程中,破损门静脉和 SMV 4～7处,但出血量少(分别为 57ml、81ml和 102ml),且易于修补止血.3例阻断时间分别为36、39和39.smin,继之顺利完成Whipple手术,术后恢复平顺.结论 此种阻断方法安全、可行,能基本控制胰后区域的门静脉和SMV的血流和损伤性出血,可成为分离胰与门静脉和SMV间紧密粘连的有效保护措施.To determine the feasibility and safety of separating close adhesion between the portal vein, superior mesenteric vein (SMV) and pancreas after combined vascular occlusion was employed. Methods: By means of occluding SMV below the pancreata, splenic arteries and veins posterior to the pancreata and portal veins superior to the pancreata consecutively, adhesion between SMV, portal vein and the head of lump pancreatitis, which is hard to deal with by fingers, was separated in 3 cases. Results: During separating procedures, 4～7 sites on portal veins and SMV were injured, with a small amount of hemorrhage (57ml, 81ml and 102ml, respectively), and were easilyrepaired. The vascular blocking time of the 3 cases was 36, 39 and 39.5 minutes. The following whipple procedures were smoothly fulfilled and all 3 patients recovered well. Conclusion: Blood flow of portal vein and SMV and traumatic hemorrhage can be radically controlled by the method of vascular occlusion, which was proved safe, performable and could be a protective method with great effect in separating close adhesion between pancreas and portal and SMV.

关 键 词：慢性胰腺炎 胰十二指肠切除术 血管阻断 胰头部肿块型胰腺炎 WHIPPLE术 

分 类 号：R657.51[医药卫生—外科学]