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中华普通外科学文献(电子版) ›› 2018, Vol. 12 ›› Issue (04) : 233 -237. doi: 10.3877/cma.j.issn.1674-0793.2018.04.005

所属专题: 文献

论著

胰十二指肠切除术联合血管切除重建的应用及疗效
杜汉朋1, 陈伟2, 黄力2, 梁力建2, 赖佳明2,()   
  1. 1. 511400 广州,南方医科大学附属何贤纪念医院 广州市番禺区何贤纪念医院普外科
    2. 510080 广州,中山大学附属第一医院胆胰外科
  • 收稿日期:2018-04-01 出版日期:2018-08-01
  • 通信作者: 赖佳明
  • 基金资助:
    广东省医学科研基金资助项目(2014A030310062)

Application and effect evaluation of pancreaticoduodenectomy combined with vascular resection and reconstruction

Hanpeng Du1, Wei Chen2, Li Huang2, Lijian Liang2, Jiaming Lai2,()   

  1. 1. Department of General Surgery, Hexian Memorial Affiliated Hospital of Southern Medical University, Hexian Memorial Hospital of Panyu, Guangzhou 511400, China
    2. Department of Biliopancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 511030, China
  • Received:2018-04-01 Published:2018-08-01
  • Corresponding author: Jiaming Lai
  • About author:
    Corresponding author: Lai Jiaming, Email:
引用本文:

杜汉朋, 陈伟, 黄力, 梁力建, 赖佳明. 胰十二指肠切除术联合血管切除重建的应用及疗效[J/OL]. 中华普通外科学文献(电子版), 2018, 12(04): 233-237.

Hanpeng Du, Wei Chen, Li Huang, Lijian Liang, Jiaming Lai. Application and effect evaluation of pancreaticoduodenectomy combined with vascular resection and reconstruction[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(04): 233-237.

目的

探讨胰十二指肠切除联合血管切除重建术的围手术期治疗策略及临床疗效。

方法

回顾性分析2010年1月至2016年2月在中山大学附属第一医院行胰十二指肠切除术的患者363例,其中胰十二指肠切除联合血管切除重建术38例,设为联合组;标准胰十二指肠切除术325例,设为标准组。对比两组患者手术时间、出血量、术后住院天数、术后胰瘘发生率、腹腔出血或消化道出血发生率、腹腔感染发生率、胆瘘发生率及围手术期病死率。

结果

联合组及标准组的手术时间分别为(7.5±2.2)h和(5.9±1.7)h,术中出血量中位数分别为500(100~4 500)ml、200(20~12 000)ml。联合组的手术时间延长、出血量增加,差异有统计学意义(t=-5.153,P<0.001;Z=-4.028,P<0.001)。联合组的术后住院天数为(20.3±14.2)d,标准组为(18.5±13.1)d,两组比较差异无统计学意义(t=-0.811,P=0.418)。联合组的并发症发生率、病死率分别为26.3%(10/38)、2.6%(1/38),标准组分别为35.4%(115/325)、1.8%(6/326),两组比较差异均无统计学意义(P=0.266、0.539)。联合组术后血管病理证实15例有癌细胞侵犯,35例移植血管通畅,3例发生门静脉血栓并发症。

结论

与单纯胰十二指肠切除术相比,胰十二指肠切除联合血管切除重建手术并不增加患者术后住院时间、围手术期并发症发生率及病死率,对于伴有血管侵犯的肿瘤患者有可能获益。

Objective

To investigate the perioperative risk and effect evaluation of pancreatico- duodenectomy (PD) with vascular resection and reconstruction.

Methods

A retrospective analysis was carried out on three hundred and sixty-three patients who had undergone PD from January 2010 to February 2016 in the First Affiliated Hospital of Sun Yat-sen University. The combination group included 38 cases underwent PD and treated with vascular resection and reconstruction, and the control group included 325 cases just undergoing PD. The differences in operative time, blood loss, postoperative hospital stay, rate of post-PD pancreatic fistula, rate of intra-abdominal or alimentary tract hemorrhage, rate of biliary fistula and perioperative mortality rate were compared between the two groups.

Results

All cases were successfully completed. The operative time in the combination group was significantly longer than control group [(7.5±2.2) h vs (5.9±1.7) h, t=-5.153, P<0.001]. The median intraoperative blood loss in combination group was 500 (100-4 500) ml, which was more than 200 (20-12 000) ml of control group (Z=-4.028, P<0.001). The combination group had no advantage in the postoperative hospital stay [(20.3±14.2) d vs (18.5±13.1) d, t=-0.811, P>0.05]. The incidence of complication and mortality in the combination group were 26.3% (10/38) and 2.6% (1/38), while 35.4% (115/325) and 1.8% (6/326) in the control group, with no significant differences between two groups (P=0.266, 0.539). Postoperative vascular pathology in the combination group confirmed that 15 patients were invaded by cancer cells, 35 of graft patency, and 3 of portal vein thrombosis complications.

Conclusion

Compared with normal PD, PD combined with vascular resection and reconstruction does not increase postoperative hospital stay, perioperative complication rate and mortality, and may help patients with vascular invasion.

表1 两组胰十二指肠切除术患者的一般资料比较
表2 两组胰十二指肠切除术患者的术后并发症比较[例(%)]
[1]
潘树波,赵红川,谢坤, 等. 增强CT联合PET/CT在胰腺癌可切除性评价中的价值[J]. 中华肝胆外科杂志, 2013, 19(10): 726-729.
[2]
张铎贤,董红锰,贺强, 等. 联合血管切除的胰十二指肠切除术研究进展和经验总结[J]. 中华肝胆外科杂志, 2015, 21(9): 644-648.
[3]
蒋奎荣,胡浩,苗毅.联合动脉切除在胰腺癌手术中的价值[J]. 临床肝胆病杂志, 2016, 32(5): 826-829.
[4]
Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after[J]. Surgery, 2017, 161(3): 584-591.
[5]
Amano R, Kimura K, Nakata B, et al. Pancreatectomy with major arterial resection after neoadjuvant chemoradiotherapy gemcitabine and S-1 and concurrent radiotherapy for locally advanced unresectable pancreatic cancer[J]. Surgery, 2015, 158(1): 191-200.
[6]
Hackert T, Weitz J, Büchler MW. Splenic artery use for arterial reconstruction in pancreatic surgery[J]. Langenbecks Arch Surg, 2014, 399(5): 667-671.
[7]
张太平,曹喆,赵玉沛.《2015年美国国立综合癌症网络胰腺癌临床实践指南(V2版)》外科相关部分解读[J]. 临床肝胆病杂志, 2015, 31(5): 654-656.
[8]
Zhou Y, Zhang Z, Liu Y, et al. Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis[J]. World J Surg, 2012, 36(4): 884-891.
[9]
蔡守旺,谢于. 联合血管切除重建的胰十二指肠切除术[J]. 肿瘤学杂志, 2015, 21(10): 814-815.
[10]
Hirono S, Kawai M, Tani M, et al. Indication for the use of an interposed graft during portal vein and/or superior mesenteric vein reconstruction in pancreatic resection based on perioperative outcomes[J]. Langenbecks Arch Surg, 2014, 399(4): 461-471.
[11]
王伟林,叶松,沈岩, 等. 同种异体血管移植在联合门静脉切除的胰腺癌根治术中的应用[J]. 中华普通外科杂志, 2016, 31(5): 365-369.
[12]
Qiyi Z, Sheng Y, Weilin W, et al. Use of allograft for portomesenteric vein interposition in radical resection of pancreatic tumor[J]. Surg Prac, 2013, 17(1): 22-27.
[13]
管小青,陈焰,顾书成, 等. 扩大胰十二指肠切除术中联合肝动脉、肝固有动脉与髂内静脉切除重应用的可行性研究[J]. 中国普外基础与临床杂志, 2012, 19(2): 181-187.
[14]
陈伟,赖佳明,张昆松, 等. 同种异体血管移植在胰十二指肠切除联合肠系膜上静脉和门静脉部分切除术中的应用[J]. 中华消化外科杂志, 2015, 14(10): 866-869.
[15]
弓毅,张雷达,丁钧, 等. 联合血管切除重建的胰十二指肠切除术治疗胰腺癌的临床意义[J]. 中华消化外科杂志, 2013, 12(6): 455-459.
[16]
符誉. 胰腺癌根治术中合并血管切除的手术指标、并发症及远期预后[J]. 实用医学杂志, 2016, 32(24): 4041-4043.
[17]
匡天佐,袁荣发,胡昌昌, 等. 联合血管切除重建的胰腺癌根治术:附12例报告[J]. 中国普通外科杂志, 2016, 25(9): 1242-1246.
[18]
Smoot RL, Christein JD, Famell MB. Durability of portal venous reconstruction following resection during pancreaticoduodenectomy[J]. J Gastrointest Surg, 2006, 10(10): 1371-1375.
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