摘要
Abstract
Objective To discuss the operative strategy of pancreaticoduodenectomy combined with vascular resection of portal vein (PV) and/or superior mesenteric vein (SMV). Methods The clinical data of 4 patients with pancreatic neck tumor encasing the PV and/or SMV received pancreaticoduodenectomy (PD) combined with vascular resection between December 1, 2015 and January 15, 2016 at the Department of Pancreatic Surgery of Changhai Hospital Affiliated to the Second Military Medical University were analyzed retrospectively. The patients received pylorus-preserving pancreaticoduodenectomy(PPPD)combined with PV resection,pancreaticoduodenectomy(PD)with prior PV-SMV shunting,PD combined with SMV resection and PPPD combined with SMV resection, respectively. Results The duration of surgery ranged from 206 to 263 min,with an average of 242 min;the length of the resected vein ranged from 20 to 35 mm, with an average of 27 mm;the duration of vascular occlusion ranged from 20 to 25 min, with an average of 22 min;artificial blood vessel was not used in all of patients;intraoperative blood loss ranged from 700 to 1700 mL,with an average of 1025mL,and intraoperative blood transfusion ranged from 800 to 1800 mL,with an average of 1100 mL. The pathology diagnosis of the 4 patients was pancreatic ductal adenocarcinoma, and the maximal diameter of the tumor ranged from 2.5 to 5.0 cm, with an average of 3.9cm. One of them had delayed gastric emptying, and the gastric tube was removed at postoperative day 15. One of them had bilioenteric anastomosis edema with partial obstruction and pancreatic fistula grade A, and all of them recovered well. The total hospitalization cost ranged from 46 694.3 to 146991.0 yuan, with an average of 80214.3 yuan. The postoperative length of hospital stay ranged from 10 to 27 days,with an average of 20 days. All the patients discharged home smoothly. ConclusionThe preoperative and intraoperative evaluation is very important for PD combined with vascular resection of PV and/or SMV. It is very important to dissect the invaded blood vessels before resection to insure the blood vessels can be reconstructed safely. It is safe and effective to resect and reconstruct the PV and/or SMV in situ before the resection of the tumor.关键词
胰十二指肠切除术/门静脉/肠系膜上静脉/血管切除Key words
pancreaticoduodenectomy/portal vein/superior mesenteric vein/vascular resection分类
医药卫生
