中国实用外科杂志

中国实用外科杂志

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胰体尾癌根治术中顺行胰体尾联合脾切除手术理念及策略探讨

吴文广1，吴向嵩1，李茂岚1，王许安1，束翌俊1，翁    昊1，曹    阳1，包润发1，陆建华1，龚    伟1，施伟斌1，顾    钧1，王雪峰1，全志伟1，彭淑牖2，刘颖斌1   

  1. 1 上海交通大学医学院附属新华医院普外科 上海交通大学医学院胆道疾病研究所，上海200092；2 浙江大学医学院附属第二医院普外科，浙江杭州310009
  • 出版日期:2015-03-01 发布日期:2015-03-02

  • Online:2015-03-01 Published:2015-03-02

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摘要：

目的    探讨胰体尾癌根治术中顺行胰体尾联合脾切除的手术理念和策略。方法    2013年1月至2014年11月上海交通大学医学院附属新华医院共为35例病人施行顺行胰体尾联合脾切除的胰体尾癌根治术，对病例资料、术中情况（平均手术时间和失血量）、术后并发症、清扫淋巴结数进行分析。结果    手术时间（160±53） min，术中出血（190±110）mL。肿瘤长径（46±18）mm，术后病理检查提示32例（91.4%）病人达到R0切除，清扫淋巴结（30.0 ± 10.6）枚，其中转移淋巴结（3.4 ± 2.6）枚。术后发生并发症10例，无围手术期死亡病例。结论    在胰体尾癌根治术中，顺行胰体尾联合脾切除有利于胰后切面的确定，并且安全可行。

关键词: 胰体尾癌, 胰腺全系膜切除, 顺行胰体尾联合脾切除, 胰后切面, 左肾静脉

Abstract:

Antegrade pancreatosplenectomy for curative resection of adenocarcinoma of the left pancreas        WU Wen-guang*，WU Xiang-song，LI Mao-lan，et al. *Institute of Biliary Tract Disease，Shanghai Jiao Tong University School of Medicine；Laboratory of General Surgery and Department of General Surgery，Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine，Shanghai 200092, China
Corresponding author：LIU Ying-bin，E-mail:laoniulyb@163.com
Abstract    Objective    To introduce antegrade pancreatosplenectomy for curative resection of adenocarcinoma of the left pancreas. Methods    From January 2013 to November 2014，35 patients underwent antegrade pancreatosplenectomy for curative resection of adenocarcinoma of the left pancreas in Department of General Surgery，Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The demographic characteristics，mean operative time，mean blood loss，postoperative complications and the number of removed regional lymph nodes were evaluated. Results The operation time was （160±53） minutes，and the blood loss was （190±110）mL. Tumor sizes were （46±18） mm. There were 32 R0 resections (91.4 %)  recorded in the pathologic reports. The resected nodal number was 30.0 ± 10.6，including  3.4 ± 2.6 metastatic lymph nodes. A totla 10 patients had postoperative complications and no perioperative death occurred. Conclusion    Antegrade pancreatosplenectomy for curative resection of adenocarcinoma of the left pancreas is favor of the dissection of the posterior pancreatic surface，which is safe and feasible.

Key words: adenocarcinomas of the left pancreas, total mesopancreas excision, antegrade pancreatosplenectomy, dissection of the posterior pancreatic surface, left renal vein