Nakao A, Takagi H
Department of Surgery II, Nagoya University School of Medicine, Japan.
Hepatogastroenterology. 1993 Oct;40(5):426-9.
We investigated perioperative complications and survival rate in 114 patients with pancreatic cancer who underwent surgical resection between July, 1981 and March, 1992 with an antithrombogenic bypass catheter of the portal vein which we have developed. With this catheter, mesenteric venous blood can be bypassed to the systemic circulation or intrahepatic portal vein to prevent portal congestion or hepatic ischemia during portal obstruction or simultaneous obstruction of the hepatic artery. All the arteries supplying, and veins draining, the pancreas are dissected prior to its manipulation, following which isolated pancreatectomy accompanied by portal vein resection can be performed. Eighty patients (70%) also underwent isolated pancreatectomy. The perioperative death rate was 9.6%, and the main factor contributing to mortality with the bypass method was not portal vein resection, but various postoperative complications, such as insufficiency of the pancreatojejunostomy and thrombosis of the hepatic artery or superior mesenteric artery after resection and reconstruction. We conclude that aggressive surgery with the bypass method increases the operability of pancreatic cancer, although auxiliary therapies combined with radical surgery are necessary to improve the therapeutic outcome for this cancer.
我们对1981年7月至1992年3月间114例行手术切除的胰腺癌患者的围手术期并发症和生存率进行了研究，这些患者使用了我们研发的门静脉抗血栓形成旁路导管。通过该导管，肠系膜静脉血可被分流至体循环或肝内门静脉，以防止门静脉梗阻或肝动脉同时梗阻期间的门静脉淤血或肝缺血。在操作胰腺之前，先解剖所有供应胰腺的动脉和引流胰腺的静脉，然后可进行孤立性胰腺切除术并同时切除门静脉。80例患者（70%）还接受了孤立性胰腺切除术。围手术期死亡率为9.6%，旁路手术导致死亡的主要因素不是门静脉切除，而是各种术后并发症，如胰空肠吻合口功能不全以及切除和重建后肝动脉或肠系膜上动脉血栓形成。我们得出结论，采用旁路手术的积极手术方式可提高胰腺癌的可切除性，尽管需要联合根治性手术的辅助治疗来改善该癌症的治疗效果。
