Cecka F, Jon B, Havel E, Lojík M, Raupach J, Bĕlobrádek Z, Neoral C, Subrt Z, Ferko A
Chirurgická klinika Lékarské fakulty Univerzity Karlovy a Fakultní nemocnice v Hradci Králové.
Rozhl Chir. 2009 Apr;88(4):192-5.
Patients with celiac axis stenosis are asymptomatic due to the rich collateral blood supply through superior mesenteric artery. Ligating and dividing gastroduodenal artery during pancreatoduodenectomy can cause ischemic threat especially to liver, less frequently stomach and spleen, or failure of anastomoses.
The authors present a case of 27-year-old female who underwent duodenopancreatectomy for pseudopapillary tumour of the head of pancreas. Celiac axis stenosis was found peroperatively and proven during angiography. Although an attempt of endovascular dilatation of celiac axis was unsuccessful, blood supply to the liver was sufficient and therefore we did not perform any other intervention to improve blood flow to the liver. Postoperative course was uneventful.
Celiac axis stenosis can be caused by tumour infiltration or lymphadenopathy in malignant disease, atherosclerosis or compression of the median arcuate ligament. The stenosis can be managed by endovascular treatment or arterial reconstruction. In conclusion the authors propose a management algorithm to prevent the consequences of celiac axis stenosis.
由于通过肠系膜上动脉有丰富的侧支血供，腹腔干狭窄患者通常无症状。在胰十二指肠切除术中结扎和切断胃十二指肠动脉会引起缺血风险，尤其对肝脏，对胃和脾脏的影响相对较少，或导致吻合口失败。
作者报告了一例27岁女性因胰腺头部假乳头状瘤接受十二指肠胰腺切除术的病例。术中发现腹腔干狭窄，并经血管造影证实。尽管对腹腔干进行血管内扩张的尝试未成功，但肝脏血供充足，因此我们未采取任何其他改善肝脏血流的干预措施。术后过程顺利。
腹腔干狭窄可由恶性疾病中的肿瘤浸润或淋巴结病、动脉粥样硬化或正中弓状韧带压迫引起。狭窄可通过血管内治疗或动脉重建进行处理。总之，作者提出了一种管理算法以预防腹腔干狭窄的后果。
