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目的:探讨肠系膜上动脉局部切除在胰腺癌外科治疗中的应用,并评估其可行性。方法:回顾分析2例胰腺癌局部广泛侵润病例,行部分肠系膜上动脉、门静脉和肠系膜上静脉联合切除并重建的手术方法及术后恢复情况,评价其临床效果。结果:2例胰腺癌患者手术过程顺利,病例1SMA部分切除,消化道重建采用child吻合法。病例2行全胰切除,将受侵的SMV、PV、SMA联同胰体癌、全胰、十二指肠、部分空肠及相应区域和腹膜后脂肪组织及淋巴结整块切除,应用脾动脉与肠系膜上动脉端端吻合。肠系膜上动脉分别阻断45min和67min,门静脉阻断31min和55min。术后行B超检查血管通畅,门静脉血流为1 550mL/min和1 620mL/min,术后6个月随访,显示血管重建(脾动脉和肠系膜上动脉)吻合通畅,1例无瘤生存3年2个月,另1例无瘤生存11月。结论:在胰腺癌肿瘤局部侵润肠系膜上静脉、门静脉和肠系膜上动脉时联合切除并行血管修复或脾动脉和肠系膜上动脉重建是一种有效的手术方法。
Objective: To investigate the application of superior mesenteric artery resection in the surgical treatment of pancreatic cancer and evaluate its feasibility. Methods: Two cases of locally invasive pancreatic cancer were retrospectively analyzed. The surgical methods and postoperative recovery of some of the superior mesenteric artery, portal vein and superior mesenteric vein were analyzed. The clinical effect was evaluated. Results: The operation of 2 patients with pancreatic cancer was successful. The cases were partially resected by 1 SMA and the anastomosis of child was performed by digestive tract reconstruction. Case 2 pancreatectomy, the invasion of SMV, PV, SMA with pancreatic cancer, total pancreas, duodenum, part of the jejunum and the corresponding region and retroperitoneal adipose tissue and lymph node resection, the application of splenic artery and Superior mesenteric artery anastomosis. The superior mesenteric artery was blocked for 45 min and 67 min, and the portal vein was blocked for 31 min and 55 min, respectively. Vascular patency was observed after B-mode ultrasonography. The portal vein blood flow was 1 550 mL / min and 1 620 mL / min after 6-month follow-up. Vascular reconstruction (splenic and superior mesenteric artery) anastomosis and 1 tumor-free survival were found Year 2 months, another case of tumor-free survival in November. CONCLUSION: Combined resection of the superior mesenteric vein, portal vein and superior mesenteric artery in pancreatic cancer is an effective surgical method for repairing vascular or repairing splenic artery and superior mesenteric artery.