Pfeiffenberger Jörn, Adam Ulrich, Drognitz Oliver, Kröger Jens C, Makowiec Frank, Schareck Wolfgang, Hopt Ulrich T
Department of Surgery, St. Franziskus Hospital, Waldstrasse 17-21, 24939 Flensburg, Germany.
Langenbecks Arch Surg. 2002 Oct;387(5-6):210-5. doi: 10.1007/s00423-002-0310-1. Epub 2002 Sep 12.
To determine the outcome of pancreatic head resection for chronic pancreatitis in the presence of celiac axis stenosis or occlusion we analyzed the blood supply of the upper abdominal organs in 11 patients before and after surgery.
Between March 1994 and April 2000 we performed 145 pancreatic head resections for chronic pancreatitis. Preoperatively 11 patients showed celiac axis stenosis at angiography. All 11 patients underwent duplex ultrasonography postoperatively and 8 had magnetic resonance angiography during follow-up.
In two cases division of the median arcuate ligament was performed to reestablish hepatic artery blood flow. No further revascularization procedures of the celiac axis were necessary. Postoperative duplex ultrasonography and magnetic resonance angiography showed normal blood flow in five patients. Four patients still had an occlusion or a significant celiac axis stenosis, and two had a stenosis only during expiration. At follow-up nine patients were completely free of abdominal pain (82%), and all had gained weight postoperatively, ranging from 5 to 16 kg.
Our data suggest that celiac axis stenosis infrequently causes complications in pancreatic head resection for chronic pancreatitis and therefore does not represent a contraindication for this procedure. Nevertheless the hepatopedal blood flow must be confirmed by palpation or duplex ultrasonography after pancreatic head resection in these patients.
为了确定在存在腹腔干狭窄或闭塞的情况下，慢性胰腺炎行胰头切除的结果，我们分析了11例患者手术前后上腹部器官的血供情况。
1994年3月至2000年4月期间，我们对145例慢性胰腺炎患者实施了胰头切除术。术前血管造影显示11例患者存在腹腔干狭窄。所有11例患者术后均接受了双功超声检查，8例在随访期间进行了磁共振血管造影。
2例患者进行了正中弓状韧带松解以重建肝动脉血流。无需对腹腔干进行进一步的血管重建手术。术后双功超声检查和磁共振血管造影显示5例患者血流正常。4例患者仍存在闭塞或明显的腹腔干狭窄，2例仅在呼气时存在狭窄。随访时，9例患者完全无腹痛（82%），且所有患者术后体重均增加，增加范围为5至16千克。
我们的数据表明，腹腔干狭窄在慢性胰腺炎胰头切除术中很少引起并发症，因此不构成该手术的禁忌证。然而，对于这些患者，在胰头切除术后必须通过触诊或双功超声检查确认肝门静脉血流情况。
