Objective To explore the safety key points of total pancreaticoduodenectomy in the era of vascular resection technology and the important factors affecting rapid postoperative recovery.Methods The clinical data of 52 patients with pancreatic cancer who underwent total pancreaticoduodenectomy in Bei-jing Chaoyang Hospital Affiliated to Capital Medical University from November 2014 to September 2022 were retrospectively analyzed,including 34 males and 18 females,aged(62±9).The intraoperative situation,incidence of postoperative complication,postoperative blood glucose control and postoperative survival rate were analyzed.Results All operations of the 52 patients were successfully completed,including 48 patients underwent total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts via artery approach.The portal vein occlusion time was(20±5)min.The incidence of postoperative complica-tions was 28.8％(15/52),including 2 cases of abnormal gastric empty,2 cases of diarrhea,2 cases of chylous fistula,4 cases of abdominal infection,1 case of gastrointestinal fistula,3 cases of gastrointestinal bleeding,and 1 case of pulmonary infection.Subcutaneous short-acting insulin injection was used to control blood glucose in the early stage after surgery,short-acting insulin combined with long-acting insulin was used for subcutaneous injection before sleep for diet recovery.All patients did not experience uncontrolled hyper-glycemia.The median survival time of 52 patients was 13 months,and the longest follow-up time was 38 months.There were 37 patients died of tumor recurrence,4 patients died of cardiovascular and cerebrovas-cular accidents,and 1 patient died of pulmonary infection in the 42 died patients.Conclusions Total pan-creaticoduodenectomy via artery approach can improve the Ro resection rate in pancreatic cancer patients with vascular invasion,the rate of postoperative complication and mortality has no significant increase.The post-operative blood sugar control is satisfactory and the quality of life is guaranteed.
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