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    find Keyword "血管切除重建" 2 results
    • 交界可切除胰頭癌新輔助化療后行聯合靜脈切除重建 LPD 的初步體會

      目的探討交界可切除胰頭癌新輔助化療后行聯合靜脈切除重建的腹腔鏡胰十二指腸切除術(laparoscopic pancreaticoduodenectomy,LPD)的安全性及可行性。方法回顧性收集并分析 2019 年 8 月至 2021 年 1 月期間于四川大學華西醫院上錦分院肝膽胰微創外科實施的 4 例交界可切除胰頭癌新輔助化療后行聯合血管切除重建的 LPD 患者的臨床資料。結果4 例患者均在完全腹腔鏡下完成手術,手術時間分別為 520、452、375 和 430 min,術中出血量分別為 300、800、150 和 200 mL,術后住院時間分別為 36、20、16 和 16 d。術后 1 例患者出現膽汁漏、行再次引流后好轉出院,1 例出現乳糜漏,導致引流管拔除時間及住院時間延長,其余 2 例未出現并發癥,正常出院。4 例患者術后病理學檢查證實均為胰頭導管腺癌,總生存期分別為 18、12、20 和 11 個月(仍存活)。結論對于高度選擇性的交界可切除胰頭癌新輔助化療后行聯合靜脈切除重建的 LPD 在經驗豐富的大的胰腺中心是安全可行的,但仍需大樣本隨機對照試驗來驗證這一結論。

      Release date:2021-10-18 05:18 Export PDF Favorites Scan
    • 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
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