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find Keyword "血管切除重建" 2 results
  • Feasibility Study on Clinical Application of Hepatic Artery,Proper Hepatic Artery,and Internal Iliac Vein Resection and Reconstruction in Extended Pancreaticoduodenectomy

    Objective To explore the feasibility of clinical application of hepatic artery (HA) or proper hepatic artery (PHA) anastomosing with superior mesenteric artery (SMA) and internal iliac vein (IIV) anastomosing with superior mesenteric vein (SMV) or portal vein (PV) in the extended pancreaticoduodenectomy combined with vascular resection.Methods The HA,PHA,SMA, SMV, PV, and IIV were dissected on 20 adult corpses, and the length, thickness,and lumen diameter of blood vessels were measured and compared with the results of multislice spiral CT scan,magnetic resonance angiography,or color Doppler in 25 patients with pancreatic head carcinoma.The extended pancreaticoduodenectomy was carried out on 5 patients of pancreatic head carcinoma with vascular invasion according to the mathcing results,and the reconstructions of HA or PHA with SMA and IIV with SMV or PV were performed.Results According to autopsy,HA-PHA was (5.50±1.50) cm in length,(0.20±0.01) mm in thickness,(5.02±1.32) mm in lumen diameter;and SMA was (4.00±1.00) cm in length,(0.21±0.01) mm in thickness,(6.05±1.06) mm in lumen diameter.The lumen diameter of left IIV,right IIV,and PV or SMV was (11.06±0.16) mm,(11.10±0.13) mm,and (11.56±0.20) mm,respectively.The thickness of left IIV,right IIV,and PV or SMV was (0.10±0.01) mm,(0.10±0.02) mm,and (0.10±0.02) mm,respectively.The multislice spiral CT scan,magnetic resonance angiography,color Doppler,and selective arteriography in vivo showed that the thickness and lumen diameter of HA-PHA and SMA were wider (0.1 mm and 0.3 mm) than those of the autopsy results,and there were no statistic significances (P>0.05),but the length of HA-PHA was longer (1-2 cm) than that of SMA,and there was statistic significance (P<0.05). The survival of 5 patients with extended pancreaticoduodenectomy combined with PHA or SMA and IIV-PV/SMV resection and reconstruction was longer than that of palliative surgery patients or giving-up patients at the same period,and no long-term complications occurred.Conclusions The vascular invasion of pancreatic head carcinoma is not an absolute contraindication of radical pancreaticoduodenectomy.The survival of 5 patients with vascular invasion of pancreatic head carcinoma in this group is prolonged by extended pancreaticoduodenectomy combined with vascular resection and reconstruction as compared with palliative surgery group at the same period.HA,PHA,and IIV are the best autologous vascular alternative materials without more complications. Being familiar with regional anatomy will guide the surgeons in extended pancreaticoduodenectomy.

    Release date:2016-09-08 10:36 Export PDF Favorites Scan
  • 交界可切除胰头癌新辅助化疗后行联合静脉切除重建 LPD 的初步体会

    目的探讨交界可切除胰头癌新辅助化疗后行联合静脉切除重建的腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)的安全性及可行性。方法回顾性收集并分析 2019 年 8 月至 2021 年 1 月期间于四川大学华西医院上锦分院肝胆胰微创外科实施的 4 例交界可切除胰头癌新辅助化疗后行联合血管切除重建的 LPD 患者的临床资料。结果4 例患者均在完全腹腔镜下完成手术,手术时间分别为 520、452、375 和 430 min,术中出血量分别为 300、800、150 和 200 mL,术后住院时间分别为 36、20、16 和 16 d。术后 1 例患者出现胆汁漏、行再次引流后好转出院,1 例出现乳糜漏,导致引流管拔除时间及住院时间延长,其余 2 例未出现并发症,正常出院。4 例患者术后病理学检查证实均为胰头导管腺癌,总生存期分别为 18、12、20 和 11 个月(仍存活)。结论对于高度选择性的交界可切除胰头癌新辅助化疗后行联合静脉切除重建的 LPD 在经验丰富的大的胰腺中心是安全可行的,但仍需大样本随机对照试验来验证这一结论。

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