中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2008年
10期
742-746
,共5页
鲁正%彭承宏%陈泉宁%周光文%沈柏用%严佶祺%程东峰%王小明%韩宝三%陶宗元%李宏为
魯正%彭承宏%陳泉寧%週光文%瀋柏用%嚴佶祺%程東峰%王小明%韓寶三%陶宗元%李宏為
로정%팽승굉%진천저%주광문%침백용%엄길기%정동봉%왕소명%한보삼%도종원%리굉위
胰腺肿瘤%胰十二指肠切除术%血管重建
胰腺腫瘤%胰十二指腸切除術%血管重建
이선종류%이십이지장절제술%혈관중건
Pancreatic neoplasms%Pancreaticoduodenectomy%Vascular reconstruction
目的 探讨联合门静脉-肠系膜上静脉切除的胰腺癌扩大根治术的临床意义和手术方法 ,以及术中医源性血管损伤的处理方法 .方法 回顾性分析242例胰腺癌扩大根治术患者临床资料,所有患者分为三组,A组为门静脉/肠系膜上静脉切除组(n=51),B组为术中发生医源性血管损伤组(n=5),C组为未行血管处理组(n=186),比较三个组的手术时间、术中输血量、血管阻断时间、平均住院天数、术后并发症及术后生存分析.结果 三个组手术时间分别为(442.85±102.32)min、(348.62±92.31)min和(315.00±83.43)min,术中平均输血量为(1430.83±1092.43)ml、(1420.22±794.41 ml)和(928.19±571.57)ml,手术时间和术中输血量相比差异有统计学意义(P<0.05),平均住院天数、术后并发症发生率差异无统计学意义(P 0.05).合并门静脉/肠系膜上静脉切除的胰腺腺癌患者术后中位生存期18.4个月,不合并门静脉/肠系膜上静脉切除组的胰腺腺癌患者术后中位生存期16.1个月,生存分析两者无明显差异(P 0.05).51例联合血管切除的患者中,行血管壁部分切除7例,行血管节段切除44例,44例血管节段切除患者中38例行端端吻合,6例行间置移植物,血管切除长度平均(2.92±1.35)cm;5例术中医源性动脉损伤的血管分别为肝动脉1例,肠系膜上动脉1例,腹腔干3例,处理方式为4例行端端吻合,1例行局部修补.结论 积极合理的开展联合门静脉/肠系膜上静脉切除的胰腺癌扩大根治术可以提高手术切除率,改善患者生活质量.由于局部的解剖关系复杂,术中较易发生医源性血管损伤,应引起术者重视并加以正确处理.
目的 探討聯閤門靜脈-腸繫膜上靜脈切除的胰腺癌擴大根治術的臨床意義和手術方法 ,以及術中醫源性血管損傷的處理方法 .方法 迴顧性分析242例胰腺癌擴大根治術患者臨床資料,所有患者分為三組,A組為門靜脈/腸繫膜上靜脈切除組(n=51),B組為術中髮生醫源性血管損傷組(n=5),C組為未行血管處理組(n=186),比較三箇組的手術時間、術中輸血量、血管阻斷時間、平均住院天數、術後併髮癥及術後生存分析.結果 三箇組手術時間分彆為(442.85±102.32)min、(348.62±92.31)min和(315.00±83.43)min,術中平均輸血量為(1430.83±1092.43)ml、(1420.22±794.41 ml)和(928.19±571.57)ml,手術時間和術中輸血量相比差異有統計學意義(P<0.05),平均住院天數、術後併髮癥髮生率差異無統計學意義(P 0.05).閤併門靜脈/腸繫膜上靜脈切除的胰腺腺癌患者術後中位生存期18.4箇月,不閤併門靜脈/腸繫膜上靜脈切除組的胰腺腺癌患者術後中位生存期16.1箇月,生存分析兩者無明顯差異(P 0.05).51例聯閤血管切除的患者中,行血管壁部分切除7例,行血管節段切除44例,44例血管節段切除患者中38例行耑耑吻閤,6例行間置移植物,血管切除長度平均(2.92±1.35)cm;5例術中醫源性動脈損傷的血管分彆為肝動脈1例,腸繫膜上動脈1例,腹腔榦3例,處理方式為4例行耑耑吻閤,1例行跼部脩補.結論 積極閤理的開展聯閤門靜脈/腸繫膜上靜脈切除的胰腺癌擴大根治術可以提高手術切除率,改善患者生活質量.由于跼部的解剖關繫複雜,術中較易髮生醫源性血管損傷,應引起術者重視併加以正確處理.
목적 탐토연합문정맥-장계막상정맥절제적이선암확대근치술적림상의의화수술방법 ,이급술중의원성혈관손상적처리방법 .방법 회고성분석242례이선암확대근치술환자림상자료,소유환자분위삼조,A조위문정맥/장계막상정맥절제조(n=51),B조위술중발생의원성혈관손상조(n=5),C조위미행혈관처리조(n=186),비교삼개조적수술시간、술중수혈량、혈관조단시간、평균주원천수、술후병발증급술후생존분석.결과 삼개조수술시간분별위(442.85±102.32)min、(348.62±92.31)min화(315.00±83.43)min,술중평균수혈량위(1430.83±1092.43)ml、(1420.22±794.41 ml)화(928.19±571.57)ml,수술시간화술중수혈량상비차이유통계학의의(P<0.05),평균주원천수、술후병발증발생솔차이무통계학의의(P 0.05).합병문정맥/장계막상정맥절제적이선선암환자술후중위생존기18.4개월,불합병문정맥/장계막상정맥절제조적이선선암환자술후중위생존기16.1개월,생존분석량자무명현차이(P 0.05).51례연합혈관절제적환자중,행혈관벽부분절제7례,행혈관절단절제44례,44례혈관절단절제환자중38례행단단문합,6례행간치이식물,혈관절제장도평균(2.92±1.35)cm;5례술중의원성동맥손상적혈관분별위간동맥1례,장계막상동맥1례,복강간3례,처리방식위4례행단단문합,1례행국부수보.결론 적겁합리적개전연합문정맥/장계막상정맥절제적이선암확대근치술가이제고수술절제솔,개선환자생활질량.유우국부적해부관계복잡,술중교역발생의원성혈관손상,응인기술자중시병가이정학처리.
Objective To explore the clinical significance and operational methods during extended radical excision for pancreatic cancer combined with portal vein ( PV )/superior mesentery vein ( SMV ) resection,and to investigate the management of iatrogenic arterial injury. Methods Clinical date of 242 patients with pancreatic cancer undergoing extended radical excision were retrospectively analyzed. All cases were divided into three groups, patients with PV/SMV resection were in group A (n = 51 ), patients with iatrogenic arterial injury during operation were in group B(n =5) ,patients without resection of vessels werein group C (n = 186 ). Operating time、volume of intraoperative blood transfusion, time of vascular interruption、the mean hospitalization,postoperative complications and postoperative survival analysis among three groups were compared with each other. Results Operating time in group A、B and C were (442. 85 ± 102. 32 ) min, ( 348. 62 ± 92. 31 ) min and ( 315.00 ± 83.43 ) min respectively, volume of intraoperative blood transfusion were ( 1430. 83 ± 1092. 43 ) ml、( 1420. 22 ± 794. 41 ) ml and ( 928. 19 ±571.57) ml respectively,operating time and volume of intraoperative blood transfusion were of significantly difference(P <0. 05) among the 3 groups,there was no significant difference in the mean hospitalization and postoperative complications. The postoperative median survival period was 18.4 months for patients of pancreatic adenocarcinoma with PV/SMV resection, the postoperative median survival period was 16. 1 months without PV/SMV resection, there was no significant difference between these by postoperative survival analysis. In the 51 cases with vessel resection,7 cases underwent partial resection of the vascular wall,44 cases underwent segmental resection, reconstruction of the portal vein was performed by end-to-end anastomosis in 38 patients, stent graft in 6 cases, the mean length of the PV/SMV resection was (2. 92 ±1.35 ) cm; latrngenic arterial injury occurred during operation in 5 patients ( 1 in hepatic artery, 1 in superior mesenteric artery, 3 in celiac think), the artery was reconstructed by end-to-end anastomosis in 4 cases,repair in 1 case. Conclusions Active and reasonable operation for pancreatic cancer with PV/SMV resection is important for improving the rate of surgical resection and the quality of life. Because of complex topography,iatrogenic vascular injury may happened frequently.
