Machado M C, Penteado S, Cunha J E, Jukemura J, Herman P, Bacchella T, Machado M A, Montagnini A L
Department of Gastroenterology, University of São Paulo Medical School, Brazil.
Hepatogastroenterology. 2001 Sep-Oct;48(41):1486-7.
BACKGROUND/AIMS: One of the determining factors for the unresectability of pancreatic head tumors is the involvement of the portal venous system. Recent reports show that the resection of tumors with portal vein involvement has similar results to lesions with same stage without portal vein invasion. The aim of this study is to present a technique that allows the resection of portal vein segments without the use of grafts and with a shorter period of intraoperative venous occlusion.
Fifteen patients with pancreatic head tumors and portal vein involvement were submitted to pancreaticoduodenectomy according to this technique. The main feature of the technique is starting the pancreatic dissection at the posterior aspect of the head of the pancreas. The superior mesenteric artery is completely dissected from the pancreatic tissues leaving the section of the pancreas and the resection of the portal vein to the last step.
Portal vein flow occlusion did not exceed 10 minutes. There were no major postoperative complications or mortality.
This maneuver allows an easier resection of the mobilized portal vein with a shorter period of venous clamping and reconstruction without the need of venous graft.
背景/目的：胰头肿瘤无法切除的决定性因素之一是门静脉系统受累。近期报告显示，切除累及门静脉的肿瘤与切除相同分期但未侵犯门静脉的病变结果相似。本研究的目的是介绍一种技术，该技术可在不使用移植物的情况下切除门静脉段，并缩短术中静脉阻断时间。
15例伴有门静脉受累的胰头肿瘤患者按照该技术接受了胰十二指肠切除术。该技术的主要特点是从胰头后方开始进行胰腺解剖。将肠系膜上动脉与胰腺组织完全分离，把胰腺的切断和门静脉的切除留到最后一步。
门静脉血流阻断时间不超过10分钟。术后无严重并发症或死亡病例。
该操作可更轻松地切除游离的门静脉，缩短静脉钳夹和重建时间，且无需静脉移植物。
