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目的提高单纯侵犯门静脉和（或）肠系膜上静脉（ＰＶ／ＳＭＶ）之Ⅱ、Ⅲ期胰头癌的根治性切除率。方法对６例Ⅱ、Ⅲ期胰头癌施行包括受侵ＰＶ／ＳＭＶ在内的扩大的胰头十二指肠切除术（ＰＤ）和广泛的区域淋巴结清扫。结果平均手术时间９小时。平均术中输血１０００ｍｌ。３例获根治性切除。术后发生切口裂开、胃动力障碍和上消化道出血各１例。但未发生胆漏、胰漏、肝肾功能衰竭等严重并发症，且无手术死亡。平均住院时间３８天。结论单纯侵犯ＰＶ／ＳＭＶ的Ⅱ、Ⅲ期胰头癌仍有５０％的可能获得根治性切除。积极的术前准备、良好的外科技术和妥善的术后处理能有效地防止ＰＤ并ＰＶ／ＳＭＶ联合切除术后严重并发症和死亡的发生。
Objective To improve the radical resection rate of stage II and III pancreatic head cancer that simply invades the portal vein and/or superior mesenteric vein (PV/SMV). Methods Six cases of stage II and III pancreatic head cancers were performed with enlarged pancreatoduodenectomy (PD) including extensive PV/SMV and extensive regional lymph node dissection. The average operation time was 9 hours. The average intraoperative blood transfusion was 1000ml. 3 cases were radically removed. Postoperative incision dehiscence, gastric dysmotility, and upper gastrointestinal hemorrhage occurred in 1 patient each. However, there were no serious complications such as bile leakage, pancreatic leakage, liver and kidney failure, and no operative death. The average hospital stay was 38 days. Conclusions There are still 50% of patients with stage II and III pancreatic head cancer who may simply invade PV/SMV may have radical resection. Active preoperative preparation, good surgical techniques and proper postoperative management can effectively prevent the occurrence of severe complications and death after PD and PV/SMV combined resection.