Duty Brian, Daneshmand Siamak
Division of Urology and Renal Transplantation, Section of Urologic Oncology, Oregon Health & Science University, Portland, Oregon 97239, USA.
J Urol. 2008 Dec;180(6):2338-42; discussion 2342. doi: 10.1016/j.juro.2008.08.028. Epub 2008 Oct 18.
Complete removal of retroperitoneal and pelvic tumors may require resection or ligation of major retroperitoneal, pelvic and mesenteric venous structures. We provide an overview of venous anatomy and collateral drainage, and review the veins that can be safely resected.
We reviewed major anatomical texts, and performed a directed MEDLINE literature search of retroperitoneal, pelvic and mesenteric venous anatomy. Resection and reconstruction of these vessels were also reviewed with an emphasis on collateral blood flow and post-resection sequelae.
The infrarenal inferior vena cava, iliac veins, left renal vein, lumbar veins, inferior mesenteric vein and splenic vein may be resected or ligated without reconstruction. Resection of the right renal vein results in renal demise in the majority of instances. The portal vein may not be resected without reconstruction. Venous reconstruction may be performed with autologous or synthetic graft material.
Most major veins in the body can be safely resected or ligated with minimal sequelae. However, it is imperative to understand venous anatomy and collateral blood flow to minimize intraoperative and postoperative complications.
完全切除腹膜后和盆腔肿瘤可能需要切除或结扎主要的腹膜后、盆腔和肠系膜静脉结构。我们概述静脉解剖和侧支引流，并回顾可安全切除的静脉。
我们查阅了主要解剖学文献，并对腹膜后、盆腔和肠系膜静脉解剖进行了定向MEDLINE文献检索。还对这些血管的切除和重建进行了回顾，重点是侧支血流和切除后后遗症。
肾下下腔静脉、髂静脉、左肾静脉、腰静脉、肠系膜下静脉和脾静脉可在不重建的情况下切除或结扎。在大多数情况下，切除右肾静脉会导致肾脏坏死。门静脉在不重建的情况下不能切除。静脉重建可使用自体或合成移植物材料。
体内大多数主要静脉可安全切除或结扎，后遗症最小。然而，了解静脉解剖和侧支血流以尽量减少术中及术后并发症至关重要。
