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目的:总结5年来所见侵犯重要血管的胰头癌诊治经验。方法:对2002～2006年间收治的61例侵犯重要血管的胰头癌的临床资料进行回顾性分析。结果:本组61例中,侵犯门静脉11例,侵犯肠系膜上血管13例,联合侵犯门静脉、肠系膜上血管12例,侵犯其他血管但无广泛转移者共13例,广泛转移者12例。61例病人中行B超检查的58例,CT检查42例,行MRCP18例,ERCP15例。20例行单纯胰十二指肠切除术,4例联合血管切除的胰十二指肠切除术,2例行联合血管切除的全胰切除术,其余行Roux-en-Y胆肠内引流术。全组无手术死亡。结论:对侵犯重要血管的胰头癌,B超可用于筛查,而CT结合MRCP/ERCP对于确定肿瘤的病变范围、血管浸润等有较高价值。对于满足适应证的病例,应积极采用联合血管切除的胰十二指肠切除术;对于不适合者,可行胆肠内引流,以改善病人生活质量和延长生存时间。
OBJECTIVE: To summarize the experience of diagnosis and treatment of pancreatic head carcinoma that has infiltrated important blood vessels in 5 years. Methods: A retrospective analysis was performed on the clinical data of 61 cases of pancreatic head carcinoma with major vascular invasion admitted between 2002 and 2006. Results: In this group of 61 cases, there were 11 cases of invasion of portal vein, 13 cases of invasion of superior mesenteric artery, 12 cases of invasion of portal vein and superior mesenteric artery, 13 cases of invasion of other blood vessels without extensive metastasis, and extensive metastasis. Among 61 patients, 58 were diagnosed by B-mode ultrasound, 42 were examined by CT, 18 were MRCP, and 15 were ERCP. 20 cases underwent simple pancreatoduodenectomy, 4 cases underwent pancreatoduodenectomy with revascularization, 2 cases underwent total pancreatectomy with revascularization, and the rest Roux-en-Y cholangio-intestine drainage . The whole group died without surgery. CONCLUSION: B-ultrasonography can be used for screening of pancreatic ductal carcinoma invaded important blood vessels. CT combined with MRCP / ERCP has high value in determining the extent of the lesion and vascular infiltration of the tumor. For patients to meet the indications, should be actively used in conjunction with the resection of the pancreatectomy; for those who are not suitable for cholangial drainage, to improve patient quality of life and prolong survival.