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目的 为提高肝门胆管癌和壶腹周围癌的手术切除率,使该区域受肿瘤浸润的血管能同时切除,血管直接重建提供解剖学依据.方法 在实施肝门胆管癌切除术及胰十二指肠切除术中,对病人的肝蒂内门静脉干、胰腺钩突内的肠系膜上静脉干进行解剖学定位并分段测量长度及可以纵向折叠的长度,以此估计可切除的静脉长度及重新再建血管的长度.结果 测量肝蒂内门静脉干104例,男性(5.8±1.99)cm,女性(5.5±O.81)cm,优势长度大于4.5cm者,男性56例占76.7%,女性25例占80.6%.胰腺钩突内段肠系膜上静脉干测量54例,男性(3.7±0.77)cm,女性(3.5±0.64)cm,优势长度大于3.0cm者,男性28例占77.6%,女性14例占77.8%.门静脉纵向折叠移动的范围在1.8～4.2cm,平均折叠2.2(1.8～2.4)cm者占66.3%,平均折叠2.8(2.5～4.2)cm者占33.7%.切除胰十二指肠后胰腺钩突内肠系膜上静脉段纵向折叠范围平均4.0cm,最长达5.2cm.结论 肝门胆管癌和壶腹周围癌切除术合并受浸血管切除在一定范围是可行的.
Objective To improve the surgical resection rate of hilar cholangiocarcinoma and periampullary carcinoma so that the tumor infiltrating blood vessels in this area can be resected simultaneously and provide an anatomical basis for direct reconstruction of blood vessels.Methods In the implementation of resection of hilar cholangiocarcinoma and pancreatic twelve In the case of nodal resection, the length of the superior mesenteric vein in the hysterosalpinx and the superior mesenteric vein in the hilus of the pancreas is measured and segmented to measure the length and the length that can be longitudinally folded so as to estimate the resectable vein length and to reseal And then reconstruct the length of the blood vessel.Results Totally 104 cases of intrahepatic portal vein were measured, with male (5.8 ± 1.99) cm, female (5.5 ± 0.81) cm and dominant length greater than 4.5cm, including 56 males (76.7%) and 25 females Accounting for 80.6% .Magnetic superior mesenteric vein was measured in 54 patients (3.7 ± 0.77) cm in females and 3.5 ± 0.64 cm in females, with a predominant length of more than 3.0 cm, with 28 males accounting for 77.6% and females 14 (77.8%) .Portral vein longitudinal folding movement in the range of 1.8 ~ 4.2cm, the average fold 2.2 (1.8 ~ 2.4) cm accounted for 66.3%, the average fold 2.8 (2.5 ~ 4.2) cm accounted for 33.7% .The removal of pancreaticoduodenal The longitudinal extent of the superior mesenteric vein segment in the hilum of the posterior pancreas was 4.0 cm in average and up to 5.2 cm in length.Conclusion Liver Ampullary carcinoma and cholangiocarcinoma resection combined baptized vascular resection is feasible in a certain range.