Suzuki Takeshi, Yoshidome Hiroyuki, Kimura Fumio, Shimizu Hiroaki, Ohtsuka Masayuki, Kato Atsushi, Yoshitomi Hideyuki, Nozawa Satoshi, Sawada Shigeaki, Miyazaki Masaru
Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
J Am Coll Surg. 2006 Jan;202(1):87-92. doi: 10.1016/j.jamcollsurg.2005.08.001. Epub 2005 Oct 13.
Advanced hepatobiliary-pancreatic malignancy occasionally involves major vasculatures, such as the portal vein or the inferior vena cava, and complete removal of the tumor is required for longterm survival. We used a left renal vein graft to reconstruct resected vessels in some patients. In this study, we evaluated early and late renal complications of this procedure.
We identified 14 patients undergoing vascular reconstruction with use of a left renal vein graft in hepatobiliary-pancreatic surgery. Renal function and graft patency were assessed by observing serum creatinine levels and radiologic findings during perioperative and followup periods.
Of these 14 patients, 7 were men and 7 were women. Diseases included hilar cholangiocarcinoma in two, gallbladder carcinoma in two, intrahepatic cholangiocarcinoma in one, pancreas carcinoma in five, hepatic metastasis in three, and mass-forming pancreatitis in one. No significant postoperative renal dysfunction was recognized, and the mean value of the maximal serum creatinine was 1.0 mg/dL during the perioperative period. Renal scintigraphy was performed in six patients postoperatively, and there was no significant left renal dysfunction. Mean followup time was 18 months after operation, and no severe renal dysfunction was found. Graft patency, which was assessed with enhanced abdominal CT, was well maintained after operation.
The left renal vein could be safely obtained and used for vascular reconstruction in resection of hepatobiliary-pancreatic malignancy without adverse effects on early and longterm renal function.
晚期肝胆胰恶性肿瘤偶尔会累及主要血管，如门静脉或下腔静脉，为实现长期生存需要完整切除肿瘤。我们在部分患者中使用左肾静脉移植物来重建切除的血管。在本研究中，我们评估了该手术的早期和晚期肾脏并发症。
我们确定了14例在肝胆胰手术中使用左肾静脉移植物进行血管重建的患者。通过观察围手术期和随访期间的血清肌酐水平及影像学检查结果来评估肾功能和移植物通畅情况。
这14例患者中，男性7例，女性7例。疾病包括肝门部胆管癌2例、胆囊癌2例、肝内胆管癌1例、胰腺癌5例、肝转移癌3例、肿块型胰腺炎1例。未发现明显的术后肾功能障碍，围手术期血清肌酐最大值的平均值为1.0mg/dL。6例患者术后进行了肾闪烁显像，未发现明显的左肾功能障碍。术后平均随访时间为18个月，未发现严重肾功能障碍。通过增强腹部CT评估的移植物通畅情况在术后得到了良好维持。
左肾静脉可安全获取并用于肝胆胰恶性肿瘤切除术中的血管重建，对早期和长期肾功能无不良影响。
