胰腺钩突肿瘤的外科手术治疗(附10例报告)  

SURGICAL TREATMENT FOR PANCREAS UNCI-NATE PROCESS CARCINOMA (A REPORT OF 10 CASES)

作　　者：李森[1] 裴永泉[1] 杜福田[1] 宋钦华[1] 庄冠一[1] 李春友[1] 王建立[1] 

机构地区：[1]山东潍坊市人民医院肝胆外科,山东潍坊261041

出　　处：《中国现代普通外科进展》2000年第2期42-44,共3页Chinese Journal of Current Advances in General Surgery

摘　　要：目的 总结胰腺钩突肿瘤的临床特点及提高手术切除率的措施.方法 对10例胰腺钩突肿瘤行根治性手术治疗,其中7例联合PV、SMV切除,3例行经典的Whipple手术.7例联合血管切除术中,5例切除静脉干长度为2.0～4.2cm,直接对端吻合成功,2例行受浸润血管侧壁切除修补术.门脉阻断时间最长40min,最短8min,未同时阻断SMA.结果 联合PV、SMV切除的7例中,有1例术后3d肝功能衰竭死亡,1例未行脾静脉与SMV吻合者,术后出现大量乳糜样腹水,经治疗40d痊愈,术后存活20个月,余5例术后生存13～29个月.末联合静脉切除的3例中,2例分别存活13个月.14个月,1例已存活11.5个月至今健在,无癌肿复发.结论 胰腺钩突肿瘤具有缺乏早期症状和邻近血管早期受侵两个特点;门脉浸润不是根治手术禁忌证;联合PV、SMV切除4～5cm以内直接对端吻合是可行的.To summarize the clinical features of pancreas uncinate process carcinoma and improve the resection rate. Methods: 10 csaes of pancreas uncinate process carcinoma received radical surgery. 7 cases were operated combining with PV and SMV resection, 3 cases underwent traditional Whipple operation. Among 7 cases subjected to PV and SMV resection, 5 cases underwent PV trunk and SMV 'post pancreas trunk FPT' resection for 2.0～4.2cm,and underwent successful end to end anastomosis directly, other 2 cases underwent PV lateral wall partial resection. The longest time of stopping PV blood flow was 40 mimutes, the shortest was 8 minutes. The blood flow of SMA was not stopped simultaneously. Results: Among 7 cases combing with PV and SMV resection,1 case died with hepatic failure 3 days after operation. 1 case without undergoing spleenic vein and SMV anastomosis had a lot of chylous ascites, lasting 40 days and was cured eventually, the survival time was 20 mouths. The other 5 cases was 13 to 29 mouths. Among 3 case undergoing traditional Whipple operation, 2 cases the survival time were 13 months and 14 months, 1 case 11.5 months and without cancerrecurrence. Conclusion: Pancreas uncinate process carcinoma is characterized with lack of early clinical symptoms and involving adjacent vein early. PV involving is not the operative contraindication; combining with PV trunk and 'PPT' of the SMV resection within 4.0～5. 0cm, and end to end anastomosis directly is feasible.

关 键 词：胰腺钩突 胰腺肿瘤 胰十二指肠切除术 手术治疗 

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