• 上海第二醫(yī)科大學附屬瑞金醫(yī)院器官外科，上海消化外科研究所(上海200025);

【摘要】　目的　探討開展胰十二指腸切除術聯(lián)合血管切除的術前、術中評估和操作方法。方法　應用術前T分級評估方法分析我院2002年1月至2005年6月期間226例胰頭癌手術患者的資料，探討胰十二指腸切除術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。結果　術前各T分級評估的符合率在85.00%以上，術前應用T分級評估胰頭癌與其血管關系的準確性為80.97%； 隨著術前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的比例也明顯增加（P＜0.001）。手術均順利，血管切除重建均在12～46 min 內完成，圍手術期并發(fā)癥率為19.61%，死亡率為1.96%。 結論　專業(yè)外科醫(yī)生的不斷實踐和經驗積累結合先進的影像學檢查技術可以進行較為準確的術前T分級評估，這有助于術者準確把握手術適應證和制定更為合理的手術方案。術中準確的評估，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至關重要。

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. 胰十二指腸切除術聯(lián)合血管切除的術前、術中評估和操作要點. 中國普外基礎與臨床雜志, 2006, 13(5): 506-510下轉514. doi: 復制

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  1. 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. 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. 3. 　 Yamamoto M, Ohashi O, Saitoh Y. Japan pancreatic cancer registry: current status [Ｊ]. Pancreas, 1998; 16(3)∶ 238.
  4. 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. 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. 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. 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. 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. 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. 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. 11. 　駱明德, 張一楚. 胰腺癌的擴大切除術 [Ｊ]. 中國實用外科雜志, 2001; 21(1)∶ 54.
  12. 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. 13. 　張圣道， 雷若慶. 胰腺癌外科治療中應注意的幾個問題 [Ｊ]. 臨床外科雜志， 2004； 12（4）∶193.