摘要
目的探讨胰腺全系膜切除(total mesopancreas excision,TMpE)技术在胰头癌行胰十二指肠切除术(pancreaticoduodenectomy,PD)中的临床价值。方法收集2014年8月至2017年8月中国人民解放军火箭军总医院肝胆外科行TMpE的PD胰头癌病例56例,并回顾性分析其临床病理资料。结果 56例胰头癌病例均行TMpE的PD,其中门静脉-肠系膜上静脉切除重建的PD 9例,保留幽门的PD 7例。平均手术时间为4.5h(3.3～8.0h),术中平均出血量为430ml(220～2 000ml),平均住院时间为16d(13～47d)。术后胰瘘7例,发生率为12.5%(7/56),其中A级胰瘘2例,B级胰瘘4例,C级胰瘘1例。术后重度并发症2例。术后病理结果显示胰腺系膜切缘48例(85.7%)达到R0切除,8例(14.3%)证实为R1切除,无R2切除病例。淋巴结平均清扫数目为23个(14～26个)。结论 TMpE技术在不增加PD手术难度和术后并发症的基础上,可以提高胰腺系膜切缘的R0切除率。
Objective To evaluate the value of total mesopancreas excision（TMpE） in pancreaticoduodenectomy for pancreatic head cancer.Methods From August 2014 to August 2017,TMpE was performed on 56 cases of pancreatic head cancer in our department,and the clinicopathologic data were analyzed retrospectively.Results All the 56 patients underwent PD with TMpE technique,including 9 cases given PD plus portal vein/superior mesenteric vein（PV/SMV）resection and reconstruction,and 7 cases given pylorus preserving pancreaticoduodenectomy（PPPD）.The mean operation time was 4.5 h（3.3 to 8.0 h）,the mean blood loss was 430 mL（220 to 2 000 mL）,and the mean hospital stay was 16 days（13 to 47 days）.Postoperative pancreatic fistula occurred in 7 cases（12.5%）,including 2 cases of grade A,4 cases of grade B and 1 case of grade C.There were 2 cases of severe postoperative complications.Postoperative pathological results confirmed mesopancreas margin R1 resection in 8 cases（14.3%）,and R0 resection in 48 cases（85.7%）.The mean number of lymph nodes collected was 23（14 to 26）.Conclusions TMpE can boost R0 resection rate without increasing the difficulty of PD and postoperative complications.
作者
张涛
李爱民
陈道媛
刘翔
金奎
刘军桂
Zhang Tao;Li Aimin;Chen Daoyuan;Liu Xiang;Jin Kui;Liu Jungui(Department of Hepatobiliary Surgery,PLA Rocket Force General Hospital,Beijing 100088,China)
出处
《腹部外科》
2018年第5期322-325,F0002,共5页
Journal of Abdominal Surgery
关键词
胰腺全系膜切除
胰腺系膜
胰十二指肠切除术
胰瘘
Total mesopancreas excision
Mesopancreas
Pancreaticoduodenectomy
Pancreatic fistula
