探讨胰十二指肠切除联合肝切除术的可行性和安全性。

回顾性分析2018年4月至2023年4月北京大学首钢医院5例实施胰十二指肠切除联合肝切除术患者的临床资料，女性1例，男性4例，年龄为（54±7.35）岁。远端胆管癌侵犯肝门部胆管1例，胰腺癌伴肝脏孤立转移1例，十二指肠间质瘤伴肝转移1例，直肠神经内分泌肿瘤（G2）伴胰腺转移伴Ⅱ型肝转移1例，右半结肠癌（T4bN1aM0）右半结肠联合十二指肠部分切除、十二指肠造口术后十二指肠吻合口局部复发、出血伴肝转移1例。对其一般资料、术中情况、术后并发症、90 d内死亡率以及预后进行分析和总结。

1例行胰十二指肠切除联合大范围肝切除（非计划性肝切除），4例行胰十二指肠切除联合小范围肝切除（均为计划性肝切除）；此外，3例行联合血管切除及重建。手术时间（559±60.97）min，术中出血（560±219.08）ml。5例患者均行R0切除。术后Clavien-Dindo并发症：Ⅲb级1例，Ⅱ级4例；在术后90 d内无死亡病例。5例均获随访，其中4例病例存活，随访12~68个月，1例于术后12个月死亡。

在谨慎把握手术适应证的前提下，通过术前精准评估和准备，以及术中规范的操作，胰十二指肠切除联合肝切除术是一种可行且安全的治疗方式。

To explore the feasibility and safety of pancreaticoduodenectomy (PD) combined with liver resection.

A retrospective analysis was conducted on the clinical data of 5 patients who underwent PD combined with liver resection at Peking University Shougang Hospital from April 2018 to April 2023. There was 1 female and 4 males, with an average age of (54±7.35) years old. One case was diagnosed distal cholangiocarcinoma invading the hilar bile duct; 1 case of pancreatic cancer with solitary metastasis of liver; 1 case of duodenal stromal tumor with liver metastasis; 1 case of rectal and pancreatic neuroendocrine tumor (G2) with type Ⅱ liver metastasis; 1 case of right colon cancer (T4bN1aM0) with partial resection of the right colon and duodenum, local recurrence of duodenal anastomosis after duodenostomy, bleeding, and liver metastasis. The general information, intraoperative condition, postoperative complications, mortality rate within 90 days, and prognosis were analyzed and summarized.

One case underwent PD combined with large-scale liver resection (unplanned liver resection), and the other 4 cases of PD combined with small-scale liver resection (all planned liver resection). In addition, there were 3 cases of combined vascular resection and reconstruction. The surgical time was (559±60.97) minutes, and intraoperative bleeding was (560±219.08) ml. All cases underwent R0 resection. Postoperative Clavien-Dindo complications: grade Ⅲb in 1 case, grade Ⅱ in 4 cases. There were no deaths within 90 days after surgery. All the 5 cases were followed up, while 4 cases survived, with a follow-up period of 12 to 68 months, and 1 case died 12 months after surgery.

Under the premise of carefully grasping the surgical indications, precisely preoperative evaluation and preparation, as well as standardized intraoperative procedures, pancreaticoduodenectomy combined with liver resection is a feasible and safe treatment method.