CAJ | 학술논문

目的观察游离肠系膜上动脉、切除肠系膜根部的扩大胰十二指肠切除术对累及肠系膜根部胰腺钩突癌的手术效果.方法 2004年1月至2007年12月为23例(男14例,女9例,年龄30～72岁)累及肠系膜根部的胰腺钩突癌患者施行了合并游离肠系膜上动脉、切除肠系膜根部的扩大胰十二指肠切除术,对手术方法、手术安全性及手术疗效进行分析.结果 12例患者施行了肠系膜根部切除的扩大胰十二指肠切除术,11例同时施行了肠系膜上静脉的切除和重建.平均手术时间(4.2±1.1)h,术中出血量(1 635±1 362)ml,术中输血量(1 609±1 462)ml.全组患者无手术死亡,6例出现轻至重度腹泻,术后住院天数9～30 d.病理示,肿瘤直径3～8 cm,合并淋巴结转移13例(57%),神经浸润20例(87%),22例手术切缘均为阴性,11例血管切除患者中有10例血管内膜浸润.随访5～42个月,4例发生肝转移,3例局部复发,1年、2年的累积生存率分别为77.2%和42.5%.结论通过游离肠系膜上动脉,对肠系膜根部组织、肠系膜上动脉周围神经以及广泛后腹膜组织的切除可以提高胰十二指肠切除术治疗胰腺钩突癌的手术彻底性,有效降低肿瘤残留,减少局部复发.手术方法是安全的.
목적 관찰유리장계막상동맥、절제장계막근부적확대이십이지장절제술대루급장계막근부이선구돌암적수술효과.방법 2004년1월지2007년12월위23례(남14례,녀9례,년령30～72세)루급장계막근부적이선구돌암환자시행료합병유리장계막상동맥、절제장계막근부적확대이십이지장절제술,대수술방법 、수술안전성급수술료효진행분석.결과 12례환자시행료장계막근부절제적확대이십이지장절제술,11례동시시행료장계막상정맥적절제화중건.평균수술시간(4.2±1.1)h,술중출혈량(1 635±1 362)ml,술중수혈량(1 609±1 462)ml.전조환자무수술사망,6례출현경지중도복사,술후주원천수9～30 d.병리시,종류직경3～8 cm,합병림파결전이13례(57%),신경침윤20례(87%),22례수술절연균위음성,11례혈관절제환자중유10례혈관내막침윤.수방5～42개월,4례발생간전이,3례국부복발,1년、2년적루적생존솔분별위77.2%화42.5%.결론 통과유리장계막상동맥,대장계막근부조직、장계막상동맥주위신경이급엄범후복막조직적절제가이제고이십이지장절제술치료이선구돌암적수술철저성,유효강저종류잔류,감소국부복발.수술방법 시안전적.
Objective To improve the prognosis and radical resection of the extended pancreaticoduodenectomy for patients with pancreatic cancer in the ucinate process involving mesentery mot. Methods From Jan. 2004 to Dec. 2007, a total of 23 ( 14 male and 9 female, aged between 30 and 72 years old) patients with pancreatic cancer in the ucinate process involving mesentery root were treated in our department. Curative resection was performed for all patients by the extended pancreaticoduodenectomy with superior mesenteric artery (SMA) isolation and mesentery root resection. The surgical procedure, the safety and prognosis were analyzed retrospectively. Results 12 patients underwent the procedure, among them 11 also underwent combined SMV partial resection and reconstruction. The operation time was (4.2 ± 1.1 ) hours, and the blood loss was ( 1 635 ± 1 362) ml with the blood transfusion of ( 1 609 ± 1 462 ) ml. There was no operation related death in this case series, and mild to severe diarrhea occurred in 6 cases. The post-operative stay ranged 9 to 30 days. The pathological examination showed that the tumor size was (5.3 ± 1.4) cm. 13 patients (57%) had one or more lymph nodes metastasis. 20 patients (87%) had nerve involvement. Among 11 patients with SMV partial resection and reconstruction, 10 patients had endangium involvement. 22 patients had negative surgical margins for all specimens. Rapid intra-operative frozen pathological examination showed negative surgical margins in one patient, however, post-operative paraffin section pathological examination revealed nerve involvement between SMA and celiac trunk. After a follow-up of 5 to 42 months, liver metastasis occurred in 4 patients, and local recurrence occurred in 3 patients. The 1-year and 2-year accumulated survival rates were 77.2% and 42.5%, respectively. Conclusions Isolation SMA and the mesentery resection in extended pancreaticodudenectomy were safe and useful. Using this modified technique, Radical operation resection could be achieved in the treatment of pancreatic cancer in uncinate process.