Ouaïssi Mehdi, Sielezneff Igor, Pirro Nicolas, Bon Mardion Rémi, Chaix Jean Batiste, Merad Abdelrhame, Berdah Stéphane, Moutardier Vincent, Cresti Silvia, Emungania Olivier, Anderson Loundou, Christian Brunet, Bernard Sastre
Service de Chirurgie Digestive et Oncologique, Pôle d'Oncologie et de Spécialité Médicale et Chirurgicale, Hôpital Timone, 13385 Marseille, France.
Gastroenterol Res Pract. 2008;2008:896320. doi: 10.1155/2008/896320. Epub 2008 Nov 23.
Recommendations for anticoagulation following major venous reconstruction for pancreatic adenocarcinoma (PA) are not clearly established. The aim of our study was to find out the relation between postoperative anticoagulant treatment and thrombosis rate after portal venous resection. Materials and methods. Between 1986 and 2006, twenty seven portal vein resections were performed associated with pancreaticoduodenectomies (n = 27) (PD).We defined four types of venous resection: type I was performed 1 cm above the confluent of the superior mesenteric vein (SMV) (n = 12); type II lateral resection and venorrhaphy at the level of the confluent SMV (n = 12); type III (n = 1) resulted from a primary end-to-end anastomosis above confluent and PTFE graph was used for reconstruction for type IV (n = 2). Curative anticoagulant treatment was always indicated after type IV (n = 2) resection, and after resection of type II when the length of venous resection was longer than >/=2 cm. Results. Venous thrombosis rate reached: 0%, 41%, and 100% for type I, II, IV resections, respectively. Among them four patients received curative anticoagulant treatment. Conclusion. After a portal vein resection was achieved in the course of a PD, curative postoperative anticoagulation does not prevent efficiently the onset of thrombosis.
对于胰腺腺癌（PA）进行主要静脉重建后的抗凝治疗建议尚未明确确立。我们研究的目的是找出术后抗凝治疗与门静脉切除术后血栓形成率之间的关系。材料与方法。在1986年至2006年期间，共进行了27例与胰十二指肠切除术（n = 27）（PD）相关的门静脉切除术。我们定义了四种静脉切除类型：I型在肠系膜上静脉（SMV）汇合处上方1 cm处进行（n = 12）；II型在SMV汇合处水平进行侧方切除和静脉修补术（n = 12）；III型（n = 1）是在汇合处上方进行原发性端端吻合，IV型（n = 2）则使用聚四氟乙烯补片进行重建。IV型（n = 2）切除术后以及II型切除术中静脉切除长度大于或等于2 cm时总是需要进行根治性抗凝治疗。结果。I型、II型、IV型切除术的静脉血栓形成率分别达到：0%、41%和100%。其中有4例患者接受了根治性抗凝治疗。结论。在PD过程中完成门静脉切除术后，根治性术后抗凝不能有效地预防血栓形成的发生。
