目的 探讨肠系膜下静脉入路法胰十二指肠切除术联合血管切除(PD+ VR)治疗胰头颈部癌的临床疗效.方法 回顾性分析2006年1月至2013年12月四川大学华西医院收治的62例行改良PD+ VR的胰头颈部癌患者的临床资料.28例行肠系膜下静脉入路法Whipple (WATIMV)患者设为WATIMV组;34例采用类似“胰腺中段切除法”横断胰腺行PD+ VR患者设为c-PD+ VR组.比较两组患者手术时间、术中出血量、术中出血量＞ 800 mL患者比例、术中输血患者比例、切除静脉长度、R1切除患者比例、阳性切缘部位、发生并发症患者比例、并发症分级及术后住院时间.采用门诊和电话方式进行随访,随访时间截至2014年12月.率或构成比的比较采用x2检验.正态分布的计量资料以(x)±s表示,采用独立样本t检验.结果 62例患者均顺利完成手术,无围术期死亡患者.WATIMV组患者手术时间,术中输血患者比例,切除静脉长度,发生并发症患者比例,并发症1、2、3、4、5级患者比例,术后住院时间分别为(325±50) min,35.7％ (10/28),(25±5)mm,46.4％ (13/28),14.3％ (4/28)、17.9％ (5/28)、14.3％ (4/28)、0、0,(15±7)d;c-PD+ VR组分别为(346±97) min,58.8％ (20/34),(24±5)mm,50.0％ (17/34),14.7％(5/34)、23.5％(8/34)、8.8％(3/34)、0、2.9％(1/34),(19±11)d;两组患者上述指标比较,差异均无统计学意义(t=0.886,x2=3.283,t =0.647,x2=0.078,1.883,t=1.666,P＞0.05).WATIMV组患者术中出血量,术中出血量＞ 800 mL患者比例,R1切除患者比例,胰腺阳性切缘患者比例,腹膜后阳性切缘患者比例分别为(534±277) mL,46.4％ (13/28),3.6％(1/28),0,3.6％(1/28);c-PD+VR组分别为(796±567) mL,67.6％(23/34),23.5％(8/34),8.8％(3/34),14.7％(5/34);两组比较,差异均有统计学意义(t=2.374,x2=2.839,4.929,6.507,P＜0.05).59例患者获得术后随访,随访率为95.2％(59/62).随访时间为15.2个月(8.0～23.0个月).随访期间,无患者发生门静脉血栓等并发症.结论 WATIMV治疗胰头颈部癌安全可行,有助于提高肿瘤根治性切除率及手术安全性.
目的 探討腸繫膜下靜脈入路法胰十二指腸切除術聯閤血管切除(PD+ VR)治療胰頭頸部癌的臨床療效.方法 迴顧性分析2006年1月至2013年12月四川大學華西醫院收治的62例行改良PD+ VR的胰頭頸部癌患者的臨床資料.28例行腸繫膜下靜脈入路法Whipple (WATIMV)患者設為WATIMV組;34例採用類似“胰腺中段切除法”橫斷胰腺行PD+ VR患者設為c-PD+ VR組.比較兩組患者手術時間、術中齣血量、術中齣血量＞ 800 mL患者比例、術中輸血患者比例、切除靜脈長度、R1切除患者比例、暘性切緣部位、髮生併髮癥患者比例、併髮癥分級及術後住院時間.採用門診和電話方式進行隨訪,隨訪時間截至2014年12月.率或構成比的比較採用x2檢驗.正態分佈的計量資料以(x)±s錶示,採用獨立樣本t檢驗.結果 62例患者均順利完成手術,無圍術期死亡患者.WATIMV組患者手術時間,術中輸血患者比例,切除靜脈長度,髮生併髮癥患者比例,併髮癥1、2、3、4、5級患者比例,術後住院時間分彆為(325±50) min,35.7％ (10/28),(25±5)mm,46.4％ (13/28),14.3％ (4/28)、17.9％ (5/28)、14.3％ (4/28)、0、0,(15±7)d;c-PD+ VR組分彆為(346±97) min,58.8％ (20/34),(24±5)mm,50.0％ (17/34),14.7％(5/34)、23.5％(8/34)、8.8％(3/34)、0、2.9％(1/34),(19±11)d;兩組患者上述指標比較,差異均無統計學意義(t=0.886,x2=3.283,t =0.647,x2=0.078,1.883,t=1.666,P＞0.05).WATIMV組患者術中齣血量,術中齣血量＞ 800 mL患者比例,R1切除患者比例,胰腺暘性切緣患者比例,腹膜後暘性切緣患者比例分彆為(534±277) mL,46.4％ (13/28),3.6％(1/28),0,3.6％(1/28);c-PD+VR組分彆為(796±567) mL,67.6％(23/34),23.5％(8/34),8.8％(3/34),14.7％(5/34);兩組比較,差異均有統計學意義(t=2.374,x2=2.839,4.929,6.507,P＜0.05).59例患者穫得術後隨訪,隨訪率為95.2％(59/62).隨訪時間為15.2箇月(8.0～23.0箇月).隨訪期間,無患者髮生門靜脈血栓等併髮癥.結論 WATIMV治療胰頭頸部癌安全可行,有助于提高腫瘤根治性切除率及手術安全性.
목적 탐토장계막하정맥입로법이십이지장절제술연합혈관절제(PD+ VR)치료이두경부암적림상료효.방법 회고성분석2006년1월지2013년12월사천대학화서의원수치적62례행개량PD+ VR적이두경부암환자적림상자료.28례행장계막하정맥입로법Whipple (WATIMV)환자설위WATIMV조;34례채용유사“이선중단절제법”횡단이선행PD+ VR환자설위c-PD+ VR조.비교량조환자수술시간、술중출혈량、술중출혈량＞ 800 mL환자비례、술중수혈환자비례、절제정맥장도、R1절제환자비례、양성절연부위、발생병발증환자비례、병발증분급급술후주원시간.채용문진화전화방식진행수방,수방시간절지2014년12월.솔혹구성비적비교채용x2검험.정태분포적계량자료이(x)±s표시,채용독립양본t검험.결과 62례환자균순리완성수술,무위술기사망환자.WATIMV조환자수술시간,술중수혈환자비례,절제정맥장도,발생병발증환자비례,병발증1、2、3、4、5급환자비례,술후주원시간분별위(325±50) min,35.7％ (10/28),(25±5)mm,46.4％ (13/28),14.3％ (4/28)、17.9％ (5/28)、14.3％ (4/28)、0、0,(15±7)d;c-PD+ VR조분별위(346±97) min,58.8％ (20/34),(24±5)mm,50.0％ (17/34),14.7％(5/34)、23.5％(8/34)、8.8％(3/34)、0、2.9％(1/34),(19±11)d;량조환자상술지표비교,차이균무통계학의의(t=0.886,x2=3.283,t =0.647,x2=0.078,1.883,t=1.666,P＞0.05).WATIMV조환자술중출혈량,술중출혈량＞ 800 mL환자비례,R1절제환자비례,이선양성절연환자비례,복막후양성절연환자비례분별위(534±277) mL,46.4％ (13/28),3.6％(1/28),0,3.6％(1/28);c-PD+VR조분별위(796±567) mL,67.6％(23/34),23.5％(8/34),8.8％(3/34),14.7％(5/34);량조비교,차이균유통계학의의(t=2.374,x2=2.839,4.929,6.507,P＜0.05).59례환자획득술후수방,수방솔위95.2％(59/62).수방시간위15.2개월(8.0～23.0개월).수방기간,무환자발생문정맥혈전등병발증.결론 WATIMV치료이두경부암안전가행,유조우제고종류근치성절제솔급수술안전성.
Objective To investigate the clinical efficacy of pancreaticoduodenectomy with vein resection (PD + VR) via inferior mesenteric vein(IMV) for tumors in the head and neck of pancreas.Methods The clinical data of 62 patients who underwent modified PD + VR for tumors in the head and neck of pancreas at the West China Hospital of Sichuan University between January 2006 to December 2013 were retrospectively analyzed.Twenty-eight patients undergoing Whipple procedure via inferior mesenteric vein were allocated to the WATIMV group,and 34 patients with pancreatic transection as central pancreatectomy undergoing PD + VR were allocated to the c-PD + VR group.The operation time,volume of intraoperative blood loss,rate of patients with intraoperative blood loss ＞ 800 mL,rate of intraoperative blood transfusion,length of vein resection,R1 resection rate,site of positive margin,incidence of complications,classification of complications and duration of postoperative hospital stay were compared between the 2 groups.Patients were followed up via outpatient examination and telephone interview till December 2014.Count data of ratio and proportion were compared by the chi-square test.Measurement data with normal distribution were presented as (x) ± s and analyzed by independent sample t test.Results All the 62 patients underwent operation successfully without perioperative death.The operation time,rate of intraoperative blood transfusion,length of vein resection,incidence of complications,incidence of grade 1,2,3,4,5 complication,duration of postoperative hospital stay were (325 ± 50) minutes,35.7 ％ (10/28),(25 ± 5) mm,46.4％ (13/28),14.3％ (4/28),17.9％ (5/28),14.3％ (4/28),0,0,(15 ± 7) days in the WATIMV group,and (346 ± 97) minutes,58.8％ (20/34),(24 ±5)mm,50.0％ (17/34),14.7％ (5/34),23.5％ (8/34),8.8％ (3/34),0,2.9％ (1/34),(19 ± 11) days in the c-PD + VR group,respectively,showing no significant difference between the 2 groups (t =0.866,x2 =3.283,t =0.647,x2 =0.078,1.883,t =1.666,P ＞ 0.05).The volume of intraoperative blood loss,rate of patients with intraoperative blood loss ＞ 800 mL,R1 resection rate,rate of positive margin in pancreas and retroperitoneal positive margin were (534 ± 277) mL,46.4％ (13/28),3.6％ (1/28),0,3.6％ (1/28) in the WATIMV group,and (796 ± 567) mL,67.6％ (23/34),23.5％ (8/34),8.8％ (3/34),14.7％ (5/34) in the c-PD + VR group,respectively,showing significant differences between the 2 groups (t =2.374,x2 =2.839,4.929,6.507,P ＜ 0.05).Fifty-nine patients were followed up for 15.2 months (range,8.0-23.0 months) with a follow-up rate of 95.2％ (59/62).No patient was complicated with portal vein thrombosis during the follow-up.Conclusion WATIMV is safe and feasible for treatment of tumors in the head and neck of pancreas,helping to improve radical resection rate of carcinoma and operation safety.
