【摘要】 目的 探討開展胰十二指腸切除術(shù)聯(lián)合血管切除的術(shù)前、術(shù)中評估和操作方法。方法 應(yīng)用術(shù)前T分級評估方法分析我院2002年1月至2005年6月期間226例胰頭癌手術(shù)患者的資料，探討胰十二指腸切除術(shù)合并血管切除的準確評估方法和操作要點。用SAS 6.12軟件包行χ2檢驗對計數(shù)資料進行分析。結(jié)果 術(shù)前各T分級評估的符合率在85.00%以上，術(shù)前應(yīng)用T分級評估胰頭癌與其血管關(guān)系的準確性為80.97%； 隨著術(shù)前T分級評估的提高，需合并血管切除才能達到標準或區(qū)域性胰十二指腸切除術(shù)的比例也明顯增加（P＜0.001）。手術(shù)均順利，血管切除重建均在12～46 min 內(nèi)完成，圍手術(shù)期并發(fā)癥率為19.61%，死亡率為1.96%。 結(jié)論 專業(yè)外科醫(yī)生的不斷實踐和經(jīng)驗積累結(jié)合先進的影像學檢查技術(shù)可以進行較為準確的術(shù)前T分級評估，這有助于術(shù)者準確把握手術(shù)適應(yīng)證和制定更為合理的手術(shù)方案。術(shù)中準確的評估，細致的解剖操作，對成功開展合并受侵血管切除的胰十二指腸切除術(shù)至關(guān)重要。
引用本文： 彭承宏,程東峰,沈柏用,韓寶三,陳泉寧,陶宗元,陳皓,李宏為. 胰十二指腸切除術(shù)聯(lián)合血管切除的術(shù)前、術(shù)中評估和操作要點. 中國普外基礎(chǔ)與臨床雜志, 2006, 13(5): 506-510下轉(zhuǎn)514. doi: 復(fù)制
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- 1. 王春友， 陶 京. 胰腺癌血管浸潤的評估及血管切除的問題 [Ｊ]. 臨床外科雜志， 2004; 12（4）∶ 198.
- 2. Tsiotos GG, Farnell MB, Sarr MG. Are the results of pancreatectomy for pancreatic cancer improving? [Ｊ]. World J Surg, 1999; 23(9)∶ 913.
- 3. Yamamoto M, Ohashi O, Saitoh Y. Japan pancreatic cancer registry: current status [Ｊ]. Pancreas, 1998; 16(3)∶ 238.
- 4. Aramaki M, Matsumoto T, Etoh T, et al. Clinical significance of combined pancreas and portal vein resection in surgery for pancreatic adenocarcinoma [Ｊ]. Hepatogastroenterology, 2003; 50(49)∶ 263.
- 5. Nakao A, Harada A, Nonami T, et al. Clinical significance of portal invasion by pancreatic head carcinoma [Ｊ]. Surgery, 1995; 117(1)∶ 50.
- 6. Fuhrman GM, Leach SD, Staley CA, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence [Ｊ]. Ann Surg, 1996; 223(2)∶ 154.
- 7. Ishikawa O, Ohigashi H, Sasaki Y, et al. Intraoperative cytodiagnosis for detecting a minute invasion of the portal vein during pancreaticoduodenectomy for adenocarcinoma of the pancreatic head [Ｊ]. Am J Surg, 1998; 175(6)∶ 477.
- 8. Wenger FA, Peter F, Zieren J, et al. Prognosis factors in carcinoma of the head of the pancreas [Ｊ]. Dig Surg, 2000; 17(1)∶29.
- 9. Howard TJ, Villanustre N, Moore SA, et al. Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head [Ｊ]. J Gastrointest Surg, 2003; 7(8)∶ 1089.
- 10. Bachellier P, Nakano H, Oussoultzoglou PD, et al. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? [Ｊ]. Am J Surg, 2001; 182(2)∶ 120.
- 11. 駱明德, 張一楚. 胰腺癌的擴大切除術(shù) [Ｊ]. 中國實用外科雜志, 2001; 21(1)∶ 54.
- 12. Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration [Ｊ]. J Gastrointest Surg, 2004; 8(8)∶ 935.
- 13. 張圣道， 雷若慶. 胰腺癌外科治療中應(yīng)注意的幾個問題 [Ｊ]. 臨床外科雜志， 2004； 12（4）∶193.