联合血管切除的胰十二指肠切除术研究进展和经验总结

摘要

Pancreatic head carcinoma could easily invade the neighboring vessels due to its own biological features and anatomical location,which increases the technique difficulty and risk,leading to low resection rate.Recently,with the progress on the surgical techniques and perioperative management,and the emergence of neoadjuvant chemoradiation,vascular invasion is no longer the surgical contraindications and pancreaticoduodenectomy combined with vascular resection has saved many patients ' lives.However,the preoperative assessment,the timing of surgery,the vessel management during the surgery,and the prevention and treatment of the postoperative complications remain controversial.In order to achieve a clear understanding on the application of pancreaticoduodenostomy combined with vascular resection,here we review the recent publications and share the experiences on pancreaticoduodenectomy with portal and/or superior mesenteric vein resection from our center,which may help improve the safety and resection rate of pancreatic carcinoma and enhance the overall therapeutic efficacy of treating pancreatic cancer.%胰头癌本身的生物学特点及其解剖位置决定其极易侵犯邻近血管,增加手术难度和风险,并导致手术切除率较低.近年来,随着手术技巧、围术期管理的加强及新辅助放化疗的出现,血管侵犯已不再是手术的禁忌,联合血管切除的胰十二指肠切除术挽救了很多患者的生命.但是,胰十二指肠切除联合血管切除重建的术前评估、手术时机选择、术中血管处理以及手术后并发症的预防和处理,仍有待业界达成广泛共识.本文综合国内外报道和我们的经验,就此问题做一综述.