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目的探讨在行扩大胰十二指肠切除联合血管切除术中应用肝动脉(HA)或肝固有动脉(PHA)与肠系膜上动脉(SMA)吻合、髂内静脉(IIV)与肠系膜上静脉(SMV)或门静脉(PV)吻合应用的可行性。方法解剖20具成人尸体的HA、PHA、SMA、SMV、PV、左IIV及右IIV,测量各血管长度、血管壁厚度和血管直径;用多层螺旋CT扫描、磁共振血管成像、彩色多普勒、选择性动脉造影检测20例胰头癌患者和本组5例患者的上述血管,并进行比对。根据比对结果,对5例已经发生血管浸润的胰头癌行扩大胰十二指肠切除术,行HA或PHA与SMA、IIV与SMV或PV吻合重建。结果尸体的HA-PHA长度为(5.50±1.50)cm,血管壁厚度为(0.20±0.01)mm,血管直径为(5.02±1.32)mm;SMA长度为(4.00±1.00)cm,血管壁厚度为(0.21±0.01)mm,血管直径为(6.05±1.06)mm。左IIV、右IIV及PV主干或SMV血管直径分别为(11.06±0.16)mm、(11.10±0.13)mm及(11.56±0.20)mm;左IIV、右IIV及PV主干或SMV的管壁厚度分别为(0.10±0.01)mm、(0.10±0.02)mm和(0.10±0.02)mm。活体多层螺旋CT扫描、磁共振血管成像、彩色多普勒、选择性动脉造影显示HA或PHA和SMA管壁厚度及血管直径分别稍比尸体解剖大0.1 mm和0.3 mm,差异均无统计学意义(P>0.05),而HA-PHA的长度比SMA长1～2 cm(P<0.05)。5例行扩大胰十二指肠切除术同时联合HA或PHA和SMA、IIV和PV或SMV切除重建患者的生存期均长于同期姑息性或放弃手术者,无一例发生远期并发症。结论有血管侵犯的胰头癌不是根治术的绝对禁忌证;就本组5例扩大胰十二指肠切除联合血管切除重建的患者比同期发生血管浸润的胰头癌仅施行探查或姑息性手术的33例患者生存时间而言,前者生存时间明显延长;HA或PHA和IIV是最好的自体血管代用材料,没有明显增加术后并发症;熟识尸体局部解剖结构对手术医生有一定的指导性意义。
Objective To explore the feasibility of using anastomosis of hepatic artery (HA) or hepatic artery (PHA) with superior mesenteric artery (SMA), ilium vein (IIV) and superior mesenteric vein (SMV) in pancreaticoduodenectomy combined with extended resection of pancreaticoduodenectomy ) Or portal vein (PV) application of the feasibility of anastomosis. Methods The HA, PHA, SMA, SMV, PV, left IIV and right IIV of 20 adult cadavers were dissected. The length of each vessel, the thickness of vessel wall and the diameter of vessel were measured. The CT images of multi-slice spiral CT, MR angiography, Le, selective angiography detection of 20 cases of pancreatic cancer patients and 5 patients in the group of the above blood vessels, and compared. According to the results of collation, 5 cases of pancreatic ductal carcinoma with vascular infiltration had undergone pancreaticoduodenectomy, and HA or PHA was reconstructed with SMA, IIV and SMV or PV. Results The body length of HA-PHA was (5.50 ± 1.50) cm, the thickness of vessel wall was (0.20 ± 0.01) mm and the diameter of vessel was (5.02 ± 1.32) mm. The length of SMA was (4.00 ± 1.00) (0.21 ± 0.01) mm, and the diameter of blood vessel was (6.05 ± 1.06) mm. The vessel diameters of the left IIV, right IIV and PV trunk or SMV vessels were (11.06 ± 0.16) mm, (11.10 ± 0.13) mm and (11.56 ± 0.20) mm, respectively. The vessel wall thicknesses of the left IIV, right IIV and PV trunk or SMV were (0.10 ± 0.01) mm, (0.10 ± 0.02) mm and (0.10 ± 0.02) mm. Multi-slice spiral CT, MR angiography, color Doppler, selective arteriography showed that the wall thickness and vessel diameter of HA or PHA and SMA were slightly larger than the autopsy 0.1 mm and 0.3 mm, respectively, with no statistical difference (P> 0.05), while the length of HA-PHA was 1 ~ 2 cm longer than SMA (P <0.05). 5 cases of extended pancreatoduodenectomy combined with HA or PHA and SMA, IIV and PV or SMV resection and reconstruction of patients were longer than the same period of palliative or surrender, and no case of long-term complications. Conclusion The vascular invasion of the pancreatic head cancer is not an absolute contraindication to radical surgery; the group of 5 patients with extended pancreatoduodenectomy combined with revascularization and reconstruction of patients with pancreatic cancer than the same period vascular invasion only exploration or palliative surgery Of the 33 patients with survival time, the former survival time was significantly longer; HA or PHA and IIV is the best autologous vascular substitute material, did not significantly increase the postoperative complications; familiar with the local anatomy of the body of the surgeon has some guidance significance.