中国实用外科杂志

中国实用外科杂志

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左右联合路径联合血管切除重建全胰腺切除术关键技术与疗效分析

郑楷炼，王    欢，倪晨明，何天霖，李    刚，胡先贵，张怡杰，金    钢   

  1. 海军军医大学附属长海医院胰腺外科，上海 200433
  • 出版日期:2019-12-01 发布日期:2019-12-23

  • Online:2019-12-01 Published:2019-12-23

摘要： 目的    探索左右联合路径联合血管重建的全胰腺切除术在治疗胰颈恶性肿瘤中的应用与临床疗效。方法    回顾性分析2015年3月至2017年3月期间12例在海军军医大学附属长海医院行左右联合路径整块切除联合血管切除重建的全胰腺切除术的胰颈恶性肿瘤病人的临床资料，重点分析该组病人的一般临床资料、手术技术、住院时间、围手术期并发症、术后病理学检查结果、切缘情况、预后等指标。结果    12例病人均为胰颈部恶性肿瘤，均侵犯胰周静脉，术中施行联合静脉切除重建。其中，男性6例，女性6例；中位年龄58岁，体重指数（BMI）中位数23.41，无术中死亡病例，中位手术时间235 min；中位出血量800 mL；中位输少浆血量600 mL；中位血管切除长度4.10 cm；中位门静脉阻断时间15 min，术后标本9例行组织大切片检查，肿瘤切缘R0切除率91.7%，所有病人术后均采用快速康复技术管理，术后疼痛缓解率达100%，术后A级胃排空障碍1例，感染2例，术后30 d无死亡病人，术后中位住院天数12 d，中位生存时间19.8个月。结论    左右联合路径整块切除联合血管重建的全胰腺切除术治疗胰腺颈部恶性肿瘤安全有效，可以提高手术安全性、改善病人的生活质量，但手术难度大，建议在高流量胰腺外科中心开展。

关键词: 全胰腺切除术, 胰腺颈癌, 静脉切除, 疗效评估

Abstract: Aapplication and clinical value of total pancreatectomy that combined vascular reconstruction with en bloc resection through both left and right pathways in pancreatic neck tumor     ZHENG Kai-lian, WANG Huan,NI Chen-ming,et al.Department of HBP Surgery, Changhai Hospital, Naval Military Medical University, Shanghai 200433,China
Corresponding author: JIN Gang,E-mail：jingang@sohu.com
Abstract    Objective    To investigate the application and clinical value of total pancreatectomy that combined vascular reconstruction with en bloc resection through both left and right pathways in pancreatic neck tumor. Methods    The clinical data concerned about 12 patients of pancreatic neck tumor accepted total pancreatectomy combined vascular reconstruction with en bloc resection through both left and right pathways in Changhai Hospital，Naval Military Medical University between March 2015 and March 2017 were analyzed retrospectively. The clinical data especially the data in general situation，operation，hospital stay，perioperative complications，postoperative pathology，condition of surgical margin，postoperative survival time and prognosis were analyzed. Results    All of the 12 patients were diagnosed with pancreatic neck tumor infringing the peripancreatic arteriovenous vein and had accepted total pancreatectomy joint with intravenous resection and reconstruction. The median age of patients was 58 years，whose median BMI reached 23.41，and the number of males was up to 6，equal as females. The information about the operation was as follows：no intraoperative death case，median surgery time being 235 min，median intraoperative blood loss being 800 mL，median plasma-reduced blood transfusion volume being 600 mL，median resection length of vessel being 4.10 cm，median time of portal vein blocking being 15 min. After the operation，9 cases were conducted to large tissue biopsy examination with R0 resection rate of 91.7%. Besides，all the patients were managed with ERAS technique with the postoperative pain relief rate of 100%. Only one case suffered from gastric emptying disorder（Grade A）and two cases had infection. No patients died 30 days after operation，whose median postoperative hospital stay was 12 days and median survival time was 19.8 months. Conclusion    The total pancreatectomy combined vascular reconstruction with en bloc resection through both left and right pathways is safe and efficient to treat pancreatic neck tumor，improving operation security and living quality of patients. However，the surgery is so difficult that it could only be applied in certain pancreatic surgery centers with high levels.

Key words: total pancreatectomy, pancreatic neck tumor, vascular resection, efficacy evaluation