联合血管重建的胰十二指肠切除问题（附45例报告）

目的：探讨联合血管重建胰十二指肠切除术的适应证和方法。方法：回顾自1994年4月－2001年3月多家协作医院45例联合血管重建胰十二指肠切除术的经验。本组45例行胰十二指肠切除，其中1例胰头癌累及结肠肝曲合并右半结肠切除，全组均联合SMPV切除，其中合并SMA和HA切除重建者分别为4例和2例，SMPV，SMA及HA三者同时重建者3例，1例胰头癌因与下腔静脉前壁粘紧不能分开则合并下腔静脉前壁部分切除修复。结果：本组病例围手术期死亡3例（7．1％），无胆胰瘘及人工血管感染并发症，病理检查结果：胰腺神经内分泌恶性肿瘤1例，其余无均为腺癌，切除血管内膜和胰腺切缘均无肿瘤浸润，本组失访2例，随访时间3－87个月，7例死于术后7个月－3年，其中6例为合并SMA，HA重建者，存活超过3年19例，超过5年6例，其余病例尚在随访中。结论：在选择适宜的病例中施行联合切除血管的胰头癌根治术可提高其切除率，延长存活时间，手术安全。

Problems of Vascular Reconstruction Combined Pancreatoduoenectomy(Report of 45 Cases)

Objective: To evaluate the surgical indications and method for regional pancreatoduodenectomy combined reconstruction of blood vessel. Methods: To review our experience of forty-five patients underwent pancreatoduodenectomy combined major vessel reconstruction in between April 1994 and March 2001. Forty five cases underwent pancreatoduodenectomy. 1 case combined right hemicolectomy. Combined SMPV reconstruction 45 cases. Among them comcomitants SMA and HA reconstruction 4 and 2 respectivety. Concomitants SMPV, SMA, HA reconstruction 3 cases. Combined ICV reconstruction one case. Results: The overall mortality was 7.1%, no complications, resection endothelium or margins of the blood vessel and pancreas were microscopically tumor free in all cases. Histological specimen examinations demonstrated 41 cases were adenocarcinoma of pancreas head, one case were neuroendocrine adenocarcinoma. With follow-up 3-87 months. Survival rate after PV/SMV for pancreatoduodectomy was more than 5 years in six patients, more than 3 years in 19 cases. Conclusion: The treatment of regional pancreatoduodectomy combined reconstruction blood vessel can be performed safely without increases morbidity and mortality but can be increased excision rates. Survival times may be prolonged in carefully selected patients with pancreatic cancer.