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目的:为使一些原本由于体积较大或侵犯门静脉而无法安全切除的胰头部肿瘤病人得到手术治疗的机会,我们尝试施行先行门-肠系膜上静脉重建的胰十二指肠切除术。方法:2004年9月～2005年6月,对5例严重侵犯肠系膜上静脉或门静脉的胰头部肿瘤病人施行先行人造血管门-肠系膜上静脉重建的扩大胰十二指肠切除术。平均年龄61岁。肿瘤平均直径4.8cm。结果:5例病人均成功施行先行门-肠系膜上静脉重建的胰十二指肠切除术,无手术死亡及严重并发症发生。平均手术时间260min,平均术中出血1570ml,平均术后住院天数18天。术后随访,平均术后生存时间为11.6个月(4～15月)。结论:由于先行建立了通畅的门静脉系统血流,有效地保证了肝脏的主要血流,减少了严重肠道淤血和肝脏缺血的发生。本术式在切除肿瘤前,即在原位完成门脉的阻断与重建,理论上能够降低手术过程中对肿瘤的挤压而导致肿瘤细胞门静脉系统播散的可能性。
OBJECTIVE: To obtain the opportunity for surgical treatment of some patients with pancreatic head and neck tumors that were otherwise not safely resected due to bulky or invasive portal vein, we attempted to perform an anterior portal mesenteric vein reconstruction pancreaticoduodenectomy. METHODS: From September 2004 to June 2005, 5 patients with pancreatic head tumors who had a serious invasion of the superior mesenteric vein or portal vein underwent extended pancreatoduodenectomy with advanced graft-versus-mesenteric vein reconstruction. The average age is 61 years old. The average tumor diameter 4.8cm. Results: All the 5 patients successfully performed pancreaticoduodenectomy with advanced portal mesenteric vein reconstruction. There was no operative death and serious complications. The average operation time was 260min, the average intraoperative bleeding 1570ml, the average postoperative hospitalization days 18 days. Postoperative follow-up, the average postoperative survival time was 11.6 months (4 ~ 15 months). Conclusion: As a result of establishing a smooth portal vein blood flow, effectively ensure the main blood flow of the liver, reducing the incidence of severe intestinal congestion and liver ischemia. This procedure in the removal of the tumor, that is, in situ completion of portal vein occlusion and reconstruction, in theory, can reduce the process of surgery on the extrusion of tumor cells leading to the possibility of portal vein dissemination.