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目的:探讨外科手术在伴有门静脉系统侵犯的胰腺癌治疗中的价值和意义。方法:回顾性分析2011年1月至2018年12月间首都医科大学附属北京朝阳医院肝胆外科收治的66例伴有门静脉系统侵犯的胰腺癌患者临床资料，所有患者均接受联合血管切除重建的胰腺癌根治性手术，归为门静脉系统侵犯组。依据肿瘤部位选择具体手术方式，依据静脉侵犯的类型和部位选择不同的血管重建方式，分析患者术中和围手术期情况。选取同期129例无门静脉侵犯的胰腺癌患者作为对照组，比较两组患者的远期预后。结果:66例患者均顺利完成手术。依据肿瘤部位行胰十二指肠根治术55例，全胰十二指肠根治术8例，胰体尾癌根治术3例。依据静脉侵犯的类型和部位行异体血管置换术43例，血管区段切除后端端吻合术16例，血管楔形切除后直接缝合7例。所有患者均无围手术期死亡。术后发生并发症19例(28.8%)，其中生化瘘6例(9.1%)，腹腔感染5例(7.6%)，腹腔出血3例(4.5%)，胃排空延迟3例(4.5%)，C级胰瘘合并腹腔出血1例(1.5%)，胆瘘1例(1.5%)。所有患者均顺利出院，术后住院天数为(20.8±9.7)d。65例患者获得随访，随访率为98.5%。门静脉系统侵犯组患者和对照组患者术后中位生存时间分别为13个月和22个月，术后1、2、3年总体生存率分别为53.3%、30.4%、23.4%和73.1%、45.8%、40.1%(n P＝0.006)。n 结论:伴有门静脉系统侵犯的胰腺癌患者总体预后较差，但对此类患者实施外科手术是安全可行的，术中可以根据静脉侵犯的具体情况采用不同的静脉重建方式。“,”Objective:To analyze the value and significance of surgical operation in the treatment of pancreatic carcinoma with portal venous system invasion.Methods:The clinical data of 66 patients of pancreatic carcinoma with portal venous system invasion admitted in Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2011 to December 2018 were retrospectively analyzed. Vascular resection and reconstruction was used on all patients who underwent radical resection for pancreatic carcinoma (portal vein system invasion group). The operation procedure was made according to the location of the pancreatic carcinoma, and the vascular reconstruction procedure was made according to the type and location of portal venous system invasion. The intraoperative and perioperative situation of the patients were analyzed. Then 129 patients of pancreatic carcinoma without portal venous system invasion in the same period were selected as the control group, and the long-term prognosis between the two groups was compared.Results:The operation was successfully in 66 patients. According to the location of the pancreatic carcinoma, 55 patients underwent pancreatoduodenectomy, 8 patients underwent total pancreatoduodenectomy and 3 patients underwent distal pancreatectomy. According to the type and location of portal venous system invasion, 43 patients underwent allogeneic vascular replacement, 16 patients underwent segmental resection with end-to-end anastomosis, and 7 patients underwent wedge resection with primary closure. There was no perioperative death in this group. The incidence of postoperative complications was 28.8%(19/66), and the incidence of biochemical fistula was 9.1%(6/66), intraperitoneal infection was 7.6%(5/66), intraperitoneal hemorrhage was 4.5%(3/66), delayed gastric emptying was 4.5%(3/66), pancreatic fistula of Grade C was 1.5%(1/66) and biliary fistula was 1.5%(1/66). All the patients were discharged successfully, and the postoperative hospital stay was (20.8±9.7) days. 65 patients were followed up, and the follow-up rate was 98.5%. The median survival time of portal venous system invasion group and control group was 13 months and 22 months, respectively. The overall 1-year, 2-year and 3-year survival rates of portal venous system invasion group and control group were 53.3%, 30.4%, 23.4% and 73.1%, 45.8% and 40.1%, respectively (n P=0.006).n Conclusions:Prognosis of pancreatic carcinoma patients with portal venous system invasion was poor, but it was safe and feasible to perform surgery for such patients. During the operation, different ways of venous reconstruction can be used according to the specific situation of venous invasion.