2022年 · 第60卷第07期

Pancreatic cancer has high malignancy and rapid progression. Radical surgical resection is a necessary condition for improving the prognosis and obtaining long-term survival of pancreatic cancer patients. The prognosis of pancreatic cancer patients after surgical resection is significantly better than that of unresectable patients^［1］However, only 15% ~20% of the cases can undergo radical surgery in clinic^［2］。 In accordance with the 2021 edition of the NCCN Clinical Practice Guidelines for Pancreatic Cancer^［3］Guidelines for Diagnosis and Treatment of Pancreatic Cancer in China (2021)^［4］It is required that the invasion circumference of the superior mesenteric artery exceeding 180° is locally advanced, and surgical resection is not recommended. With the improvement of surgical technology and the cutting-edge exploration of tumor treatment, foreign pancreatic centers have attempted to reconstruct some cases of pancreatic cancer that invade mesenteric artery and vein simultaneously under the premise of effective neoadjuvant therapy^{［5, 6, 7］}。 Since July 2021, our center has tried to perform "total pancreas combined with superior mesenteric artery and vein resection, allogeneic blood vessel replacement reconstruction of portal vein-superior mesenteric vein (or portal vein-superior mesenteric vein end-to-end anastomosis), and in situ inversion of splenic artery instead of superior mesenteric artery reconstruction" for cases with simultaneous invasion of superior mesenteric artery and vein. The case information is reported as follows. Professor Yang Yinmo (Peking University First Hospital): This article reports the data of 3 patients with locally advanced pancreatic cancer, all of whom underwent whole pancreas combined with superior mesenteric vein and superior mesenteric artery resection and reconstruction. The surgical procedure was reported in detail, among which the in situ inversion of splenic artery and the distal reconstruction after partial resection of superior mesenteric artery were quite technical highlights. One of the three patients died perioperatively, and the other two had a good prognosis in the near term.

PatientFemale, 60. Because the pancreatic head was found to occupy space for 1 week during physical examination, it was proposed to be diagnosed as "malignant tumor of pancreatic head" and admitted to the Department of Pancreatic Surgery, Zhongshan Hospital affiliated to Fudan University on July 7, 2020. The patient has no abdominal distension, abdominal pain, anorexia, jaundice, fever and other discomfort since the onset of the disease. Five days before admission, enhanced MRI and PET-CT examination were performed in another hospital, and it was considered to be pancreatic uncinate process carcinoma. The patient had a history of hypertension for more than 10 years, and received oral losartan potassium hydrochlorothiazide 62.5 mg once a day, and self-claimed that his blood pressure was controlled. More than 30 years ago, he underwent abdominal mass resection due to "tuberculosis", and the details are unknown. The general physical examination was not special, and there were no obvious positive signs in the abdomen. Blood and urine routine, biochemical indexes and tumor markers were all normal when admitted to the hospital. Enhanced MRI and peripancreatic CT angiography all showed that it was duodenal stromal tumor. The maximum diameter of the tumor was 6 cm, horseshoe-shaped, and the medial margin was located behind the superior mesenteric vein (Figure 1).