目的 探讨12例运用肠系膜上静脉解剖技术于胰腺切除病例中的经验和结果.方法 回顾性分析2008年1月至2010年12月采取经横结肠系膜下途径解剖肠系膜上静脉,再完成胰腺切除的方法,行困难胰腺切除12例的临床资料,总结病人的围手术情况和并发症发生率.结果 本组12例中,胰头癌8例,十二指肠乳头癌2例,胰体尾癌2例.行胰十二指肠切除术10例,胰体尾切除术2例；行肠系膜上静脉切除重建术6例.术中平均出血量为(600±325) ml,平均输血量为(400±260)ml.术后发生伤口感染3例,腹腔感染1例,胰漏1例,上消化道出血1例,均经保守治疗治愈,无围手术期死亡.结论 肠系膜上静脉解剖提高了困难胰腺切除的成功率,手术安全、可行,值得推广.%Objective To evaluate the importance of manipulation of superior mesenteric vein (SMV) for complicated pancreatectomy with malignant tumor. Methods Twelve patients underwent complicated pancreatectomy with malignant tumor in our hospital between Jan. 2008 and Dec. 2010. The procedure was started to exposure SMV under transverse mesocolon, and then pancreatectomy was done. The clinic data and operative complication were analyzed. Results Of 12 patients with malignant tumor, 8 located on pancreatic head, 2 pancreatic body and tail, and 2 duodenum. Ten underwent pancreaticoduodenectomy, and 2 underwent resection of pancreatic body and tail. Six underwent reconstruction of SMV. Intraoperative hemorrhage volume was (600 ±325)ml, and blood transfusion volume was (400 ±260)ml. Wound infection occurred in 3 cases, abdominal infection in 1 case, pancreatic fistula in 1 case, and upper gastrointestinal bleeding in 1 case, which was cured conservatively. Perioperative death was not observed. Conclusion The manipulation of SMV improved the resection rate of pancreatic malignant tumor, which is safe, feasible and valuable.
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