Objective To analyze the application of vascular replacement technique with allogenic blood vessel in radical resection for pancreatic carcinoma. Methods The clinical data of 33 patients with vascular invasion of pancreatic carcinoma who underwent radical resection from April 2013 to April 2017 in Department of Hepatobiliary Surgery,Beijing Chaoyang Hospital were retrospectively analyzed. There were 14 males and 19 females with age of(62.5 ± 10.6)years(ranging from 35 to 78 years). Vascular replacement technique with allogenic blood vessel was used on all patients who underwent radical resection for pancreatic carcinoma. The operation procedure was made according to the specific location of the carcinoma,and the allogenic blood vessel was selected according to the type of vascular invasion. The matching vessel was selected for replacement to the patient who was invaded only one vessel. And the"Y"type of iliac vein was selected for replacement to the patient who was invaded the confluence of portal vein, splenic vein and superior mesenteric vein. After the operation,the patients were followed up by telephone and outpatient review. Results All of 33 patients were successfully completed the operations. There were 28 patients underwent pancreaticoduodenectomy with vascular replacement,and 5 patients underwent total pancreatectomy with vascular replacement. All the patients were confirmed pancreatic carcinoma and R0 resection according to the postoperative pathology. There were 16 patients with the carcinoma invasion the confluence of portal vein,splenic vein and superior mesenteric vein,12 patients with the carcinoma invasion the superior mesenteric vein,and 5 patients with the carcinoma invasion the portal vein. There was no perioperative death in this group and no complications related to allogenic blood vessel. The incidence of postoperative complications was 18.2%(6/33),and the incidence of pancreatic fistula was 6.1%(2/33), all of which were biochemical fistula. There were 32 patients were followed up,and the follow-up rate was 96.9%. The median survival time was 14.6 months. The half-year,1-year and 2-year survival rates were 75.6%,37.6% and 27.4%. Conclusion The application of vascular replacement technique with allogenic blood vessel for pancreatic carcinoma has a great significance for improving the R0 resection rate and the prognosis of patients.%目的 探讨异体血管置换技术在合并血管侵犯的胰腺癌根治性手术中的应用价值.方法 回顾性分析2013年4月至2017年4月首都医科大学附属北京朝阳医院肝胆外科收治的33例伴有血管侵犯的胰腺癌患者资料,男性14例,女性19例;年龄(62.5±10.6)岁(范围:35~78岁).所有患者均接受联合异体血管置换的胰腺癌根治性手术,依据肿瘤具体位置决定具体手术方式,依据肿瘤侵犯静脉的类型和位置选用不同种类的异体血管进行置换.对于单独侵犯一支血管的患者,置换血管选用异体相匹配血管;对于侵犯静脉汇合部的患者,置换血管选用异体髂静脉分叉"Y"形血管.术后对患者进行电话随访联合门诊复查.结果 本组33例患者均顺利完成手术,行联合异体血管置换的根治性胰十二指肠切除术28例,行联合血管置换的全胰十二指肠切除术5例.术后病理学检查结果证实均为胰腺癌且达到R0切除:肿瘤侵犯肠系膜上静脉、门静脉和脾静脉汇合处16例,单独侵犯肠系膜上静脉12例,单独侵犯门静脉5例.本组患者均顺利出院,无围手术期死亡患者,无发生移植血管相关并发症患者.术后发生并发症6例,发生率为18.2%,其中胰瘘2例,发生率为6.1%,均为生化瘘.术后32例患者获得随访,随访率为96.9%.术后中位生存时间为14.6个月.术后6个月、1年和2年患者的总体生存率分别为75.6%、37.6%和27.4%.结论 异体血管置换技术应用于伴有血管侵犯的胰腺癌患者的手术对于提高患者的R0切除率,改善患者预后具有积极意义.
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