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目的 总结胰腺钩突肿瘤的临床特点及提高手术切除率的措施.方法 对10例胰腺钩突肿瘤行根治性手术治疗,其中7例联合PV、SMV切除,3例行经典的Whipple手术.7例联合血管切除术中,5例切除静脉干长度为2.0～4.2cm,直接对端吻合成功,2例行受浸润血管侧壁切除修补术.门脉阻断时间最长40min,最短8min,未同时阻断SMA.结果 联合PV、SMV切除的7例中,有1例术后3d肝功能衰竭死亡,1例未行脾静脉与SMV吻合者,术后出现大量乳糜样腹水,经治疗40d痊愈,术后存活20个月,余5例术后生存13～29个月.末联合静脉切除的3例中,2例分别存活13个月.14个月,1例已存活11.5个月至今健在,无癌肿复发.结论 胰腺钩突肿瘤具有缺乏早期症状和邻近血管早期受侵两个特点;门脉浸润不是根治手术禁忌证;联合PV、SMV切除4～5cm以内直接对端吻合是可行的.
Objective To summarize the clinical features of pancreatic tumors and to improve the surgical resection rate. Methods Radical surgery was performed on 10 cases of uncinate tumors of the pancreas, of which 7 cases were combined with PV and SMV resection and 3 cases were treated with classic Whipple surgery. In combined vascular resection, the length of excised veins was 2.0-4.2 cm in 5 patients. The direct anastomosis was successful, and 2 cases were treated by invasive vascular wall excision. The duration of portal vein occlusion was the longest 40 min and the shortest 8 min. SMA was blocked. Results Among the 7 patients who underwent PV and SMV resection, 1 patient died of hepatic failure 3 days after surgery, 1 patient had no splenic vein and SMV anastomosis, and there was a large amount of chylous ascites after surgery. He recovered after 40 days of treatment. After surviving for 20 months, the remaining 5 patients survived for 13 to 29 months after surgery. Of the 3 patients who underwent combined venous resection, 2 survived for 13 months and 14 months respectively, and 1 patient survived 11.5 months after surviving. There was no recurrence of cancer. Conclusion The pancreatic tumor has two characteristics: lack of early symptoms and early invasion of adjacent blood vessels; portal vein invasion is not a contraindication to radical surgery; combined PV, SMV resection within 4 ~ 5cm within the direct end to end anastomosis is feasible.