【Abstract】 Objective To investigate the preoperative and intraoperative evaluation and the operative methods of pancreaticoduodenectomy combined with resection of involved blood vessel. Methods The materials of 226 cases of carcinoma of head of pancreas, which were collected from January 2002 to June 2005, were assessed according to the T-grade evaluative method and were summarized into a more accurate method of preoperative and intraoperative evaluation and an operative method of the pancreaticoduodenectomy combined with vascular resection. The statistical analyses were performed by SAS 6.12 Stat software package with χ2 test for categorical data. Results The coincidence of every preoperative evaluations on pancreaticoduodenectomy with T-grade method were more than 85.00% and the accurate rate of evaluation on relationship between tumor and blood vessel was 80.97%. As the degree of T-grade increased, the proportion of requiring pancreaticoduodenectomy combined with vascular resection increased significantly as well (P＜0.001). All operations were smoothly done and the reconstruction of removed vascular took 12 to 46 minutes. The complication rate and the mortality rate of perioperative period were 19.61% and 1.96%, respectively. Conclusion With more practice, experience and the advanced imaging technology, it is possible for professional surgeon to evaluate more accurately on the pancreaticoduodenectomy combined with vascular resection by using the preoperative T-grade method. T-grade evaluative method is useful for operator to assess the indication accurately and to design the operative schedule reasonably. Accurate operational evaluation and careful operation are also important for pancreatoduodenectomy combined vascular resection.
Citation：
PENGChenghong,CHENG Dongfeng,SHEN Baiyong,HAN Baosan,CHEN Quanning,TAO Zongyuan,CHEN Hao,LI Hongwei.. Preoperative and Intraoperative Evaluation and Operative Methods of Pancreaticoduodenectomy Combined with Vascular Resection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2006, 13(5): 506-510下转514. doi:
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Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration [Ｊ]. J Gastrointest Surg, 2004; 8(8)∶ 935.
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张圣道， 雷若庆. 胰腺癌外科治疗中应注意的几个问题 [Ｊ]. 临床外科杂志， 2004； 12（4）∶193.
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- 1. 王春友， 陶 京. 胰腺癌血管浸润的评估及血管切除的问题 [Ｊ]. 临床外科杂志， 2004; 12（4）∶ 198.
- 2. Tsiotos GG, Farnell MB, Sarr MG. Are the results of pancreatectomy for pancreatic cancer improving? [Ｊ]. World J Surg, 1999; 23(9)∶ 913.
- 3. Yamamoto M, Ohashi O, Saitoh Y. Japan pancreatic cancer registry: current status [Ｊ]. Pancreas, 1998; 16(3)∶ 238.
- 4. Aramaki M, Matsumoto T, Etoh T, et al. Clinical significance of combined pancreas and portal vein resection in surgery for pancreatic adenocarcinoma [Ｊ]. Hepatogastroenterology, 2003; 50(49)∶ 263.
- 5. Nakao A, Harada A, Nonami T, et al. Clinical significance of portal invasion by pancreatic head carcinoma [Ｊ]. Surgery, 1995; 117(1)∶ 50.
- 6. Fuhrman GM, Leach SD, Staley CA, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence [Ｊ]. Ann Surg, 1996; 223(2)∶ 154.
- 7. Ishikawa O, Ohigashi H, Sasaki Y, et al. Intraoperative cytodiagnosis for detecting a minute invasion of the portal vein during pancreaticoduodenectomy for adenocarcinoma of the pancreatic head [Ｊ]. Am J Surg, 1998; 175(6)∶ 477.
- 8. Wenger FA, Peter F, Zieren J, et al. Prognosis factors in carcinoma of the head of the pancreas [Ｊ]. Dig Surg, 2000; 17(1)∶29.
- 9. Howard TJ, Villanustre N, Moore SA, et al. Efficacy of venous reconstruction in patients with adenocarcinoma of the pancreatic head [Ｊ]. J Gastrointest Surg, 2003; 7(8)∶ 1089.
- 10. Bachellier P, Nakano H, Oussoultzoglou PD, et al. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? [Ｊ]. Am J Surg, 2001; 182(2)∶ 120.
- 11. 骆明德, 张一楚. 胰腺癌的扩大切除术 [Ｊ]. 中国实用外科杂志, 2001; 21(1)∶ 54.
- 12. Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration [Ｊ]. J Gastrointest Surg, 2004; 8(8)∶ 935.
- 13. 张圣道， 雷若庆. 胰腺癌外科治疗中应注意的几个问题 [Ｊ]. 临床外科杂志， 2004； 12（4）∶193.
