摘要目的 探讨壶腹部周围恶性肿瘤患者胰腺钩突部根治性完整切除的技巧和方法.方法 2005年3月至2010年3月共连续完成了306例壶腹部周围恶性肿瘤的根治性胰十二指肠切除(RPD),男性169例,女性137例;发病年龄37～79岁,平均58岁.其中胰头颈部肿瘤151例,胆总管下端肿瘤48例,壶腹部肿瘤55例,十二指肠乳头部肿瘤52例.采用肠系膜上血管交换和胰腺钩突部血流控制法顺利完成所有患者的钩突部根治性完整切除;消化道重建均采用Child法;胰肠吻合均采用简化的捆绑式胰肠吻合术.结果 306例接受RPD的患者中,手术时间4～6 h,出血量200～600 ml,无术中及术后胰腺钩突部位的出血.术后患者出血发生率和病死率分别为3.3%和0.9%;术后胰瘘和胆瘘发生率分别为1.6%和0.6%,胆瘘、胰瘘患者均在B超引导下经穿刺引流等保守治疗后痊愈.随访至2010年3月,未见因肠系膜上血管周围肿瘤复发死亡患者.结论 采用肠系膜上血管交换和胰腺钩突部血流控制法可顺利完成壶腹部周围恶性肿瘤患者胰腺钩突部的根治性完整切除;并可减少术中出血量,缩短手术时间,减少肠系膜上静脉和(或)肠系膜上动脉的误切,可避免因胰腺钩突部残留引起的术后胰腺组织坏死脱落、感染和出血;还可从理论上减少肿瘤细胞播散的机会.

abstractsObjective To investigate the methods and skills of integrated radical resection of uncinate process of the pancreas for patients with periampullary malignant tumor. Methods From March 2005 to March 2010,306 cases of radical pancreaticoduodenectomy(RPD) of periampullary malignant tumor had been continuously performed. By exchanging superior mesenteric artery and controlling blood stream of pancreatic uncinate process,the integrated radical resection of uncinate process for these patients had been successfully completed. Deal with restitution of alimentary tract by all using Child method. The method of simplify binding pancreaticojejunostomy was carried out to pancreatico-jejunal anastomosis. The cases included 169 male and 137 female with 37-79 years old, and the mean age was 58 years. Tumor types included 151 pancreatic head and neck tumors,48 distal bile duct tumors,55 ampullary tumors and 52 duodenal papilla tumors. Results Among the 306 cases with RPD,operation time were 4-6 h and the blood loss were 200-600 ml with no intraoperative and postoperative bleeding of pancreatic uncinate process site. The incidence rates of postoperative bleeding and mortality were 3. 3% and 0. 9% respectively. Theincidence rates of postoperative pancreatic fistula and biliary fistula incidence were 1.6% and 0. 6% respectively. And patients with fistula had well recovered by expectant treatment of ultrasound-guided puncture and drainage. Follow-up to March 2010,there were no patients died from the recurrence of superior mesenteric vascular tumor. Conclusions By exchanging superior mesenteric artery and controlling blood stream of pancreatic uncinate process, the integrated radical resection of uncinate process for those patients who have periampullary malignant tumor can be successfully completed. It can reduce the operating bleeding,operating time and the miscut of superior mesenteric vein and (or)superior mesenteric artery, it can avoid postoperative pancreas necrosis off, infection and hemorrhage caused by the pancreas uncinate process residues, and it also theoretically reduces the chance of tumor cells spreading.