目的

探索胰腺癌动脉受侵的类型及手术策略。

方法

回顾性分析2021年7月至2024年5月中国人民解放军火箭军特色医学中心收治的17例胰腺癌局部晚期患者的临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男9例，女8例；年龄47～71岁，中位年龄61岁。胰腺中低分化腺癌13例，胰腺腺鳞癌2例，胰腺导管腺癌1例，壶腹部腺癌（胰胆管型）1例。肿瘤同时侵犯门静脉-肠系膜上静脉及肠系膜上动脉患者10例，侵犯门静脉-肠系膜上静脉及肝总动脉3例，侵犯门静脉-肠系膜上静脉及肝固有动脉2例，侵犯门静脉-肠系膜上静脉及腹腔干2例。根据动脉受侵部位分为Ⅰ、Ⅱ、Ⅲ型，每个分型再分为不同亚型，观察术中、并发症及术后恢复等围手术期情况。

结果

17例患者手术顺利实施。根据胰腺癌动脉受侵不同类型采用不同手术方式，其中Ⅰ型7例（Ⅰa型3例，Ⅰb型3例、Ⅰd型1例），Ⅱ型10例。术中出血量500～3 600 ml，中位出血量1 153 ml；17例患者均接受输血。手术时间6.5～13.0 h，中位手术时间9.5 h。ICU住院时间2～10 d，中位ICU住院时间5 d。住院时间15～48 d，中位住院时间30 d。围手术期1例死于术后吻合口漏、腹腔感染，其余16例患者均顺利出院。并发症6例，分别为消化道出血3例、腹腔出血1例、胆漏1例、淋巴漏1例。消化道出血患者1例胃镜下止血成功，2例抑酸、止血、禁食水、胃肠减压等保守治疗成功；腹腔出血患者停用抗凝药、对症止血治疗成功；胆漏及淋巴漏患者通畅引流保守治疗成功。16例患者接受随访，截止至投稿日期，6例患者健在，10例死亡。

结论

对于胰腺癌局部晚期患者，根据肿瘤侵犯部位、侵犯范围及程度分型，选择不同的手术方式是安全、可行的。

Objective

To investigate the classification for arterial invasion of pancreatic cancer and the corresponding surgical strategies.

Methods

Clinical data of 17 patients with locally advanced pancreatic cancer admitted to PLA Rocket Force Characteristic Medical Center from July 2021 to May 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them， 9 patients were male and 8 female， aged from 47 to 71 years，with a median age of 61 years. 13 cases were diagnosed with moderately and poorly differentiated pancreatic adenocarcinoma， 2 cases of pancreatic adenosquamous carcinoma， 1 case of pancreatic ductal adenocarcinoma and 1 case of ampullary adenocarcinoma （pancreaticobiliary type）. 10 patients were diagnosed with portal veinsuperior mesenteric vein and superior mesenteric artery invasion， 3 cases of portal vein-superior mesenteric vein and common hepatic artery invasion， 2 cases of portal vein-superior mesenteric vein and proper hepatic artery invasion， and 2 cases of portal vein-superior mesenteric vein and celiac trunk invasion， respectively.According to the arterial invasion sites， all patients were divided into typeⅠ， Ⅱand Ⅲ， and each type was further divided into different subtypes. Perioperative situations such as intraoperative situations， complications and postoperative recovery were observed.

Results

The surgerics of 17 patients were completed successfully.According to different types of arterial invasion of pancreatic cancer， different surgical methods were adopted. Among them， 7 cases were classified as type Ⅰ （3 cases of typeⅠa， 3 cases of type Ⅰb and 1 case of typeⅠd） and 10 cases of typeⅡ. Intraoperative blood loss was 500-3 600 ml， with a median of 1 153 ml.All 17 patients received blood transfusion. The operation time was 6.5-13.0 h， with a median of 9.5 h. The length of ICU stay was 2-10 d， with a median of 5 d. The length of hospital stay was 15-48 d， with a median of 30 d. Perioperatively， 1 patient died of postoperative anastomotic leakage and abdominal infection， and the remaining 16 patients were discharged. 6 cases developed complications， including 3 cases of gastrointestinal bleeding， 1 case of abdominal bleeding， 1 case of bile leakage and 1 case of lymphatic leakage. 1 patient with gastrointestinal bleeding was successfully treated with gastroscopic hemostasis， and 2 patients were treated with conservative treatment such as acid-suppressive therapy， hemostasis， fasting and nasogastric tube decompression， etc. Patients with abdominal bleeding were treated by terminating use of anticoagulants. Those with bile and lymphatic leakage were successfully treated with drainage and conservative treatment. 16 patients were followed up. As of the submission date， 6 patients survived and 10 patients died.

Conclusions

For patients with locally advanced pancreatic cancer， it is safe and feasible to adopted corresponding surgical interventions according to the site， scope and degree of arterial invasion.