联合门静脉或肠系膜上静脉切除胰十二指肠切除术应用及技术要点OA

Pancreaticoduodenectomy combined with portal vein and/or superior mesenteric vein resection is an important surgical procedure for pancreatic cancer with portal vein-superior mesenteric vein invasion,which can improve the R0 resection rate and prolong patient survival.The complex vascular anatomy and meticulous vascular reconstruction techniques involved impose higher demands on surgeons.Preoperatively,imaging assessment is required to determine the extent of venous invasion and exclude distant metastasis,with strict adherence to surgical indications;intraoperatively,priority should be given to vascular exploration to assess resectability,following the principle of exploration before transection,with individualized preservation and division of the major branches of the portal venous system to maintain gastrointestinal venous return;reconstruction methods-including partial resection with primary closure,segmental resection with end-to-end anastomosis,or interposition grafting-should be selected based on the circumferential extent and length of venous involvement;postoperatively,prevention and management of complications such as hemorrhage,thrombosis,and venous stenosis are essential,with standardized anticoagulation therapy.Furthermore,venous tumor invasion and absence of adjuvant chemotherapy are identified as adverse prognostic factors.Strict indication selection and optimal surgical timing,combined with greater emphasis on comprehensive treatment and perioperative management,are essential to further reduce surgical complications and improve long-term survival.