Division of Vascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97201-3098, USA.
J Vasc Surg. 2010 Mar;51(3):662-6. doi: 10.1016/j.jvs.2009.09.025. Epub 2010 Jan 18.
Patients with pancreatic tumors may have portal vein (PV) and/or superior mesenteric vein (SMV) invasion. In such cases, lower extremity veins can provide an autogenous conduit for PV/SMV reconstruction. Little data exist, however, describing the technique of PV/SMV reconstruction, patency of such reconstructions, and the morbidity of using lower extremity veins for PV/SMV reconstruction during pancreaticoduodenectomy.
Thirty-four patients underwent PV/SMV reconstruction during pancreaticoduodenectomy using lower extremity vein. The saphenous vein was preferred for patching and femoral vein for replacement. We analyzed preoperative imaging, reconstruction patency, vein harvest morbidity, and late mortality.
The mean age was 62.6 years. All 34 patients had preoperative computed tomography (CT) imaging and/or endoscopic ultrasound (EUS) scan. Fourteen of the 34 patients had evidence of PV/SMV invasion on CT or EUS scans, 14 did not, and six studies were indeterminate. Twenty-five patients had follow-up imaging, and 22 (88%) had patent reconstructions. Fifteen patients had PV/SMV replacement using femoral vein. Seven of these 15 had minor postoperative lower extremity edema that resolved over time, five had wound complications from the femoral vein harvest site, three of which required minor operative procedures for treatment. Fifteen patients had PV/SMV patching with the great saphenous vein, none had postoperative wound problems, and one had minimal postoperative lower extremity edema. Four patients had PV/SMV patching using femoral vein, none had postoperative wound problems, and one had minimal postoperative lower extremity edema. Compared with patients undergoing pancreaticoduodenectomy without PV/SMV reconstruction, by Kaplan-Meier analysis, there was no difference in late mortality.
Preoperative imaging may fail to detect PV/SMV involvement in patients undergoing pancreaticoduodenectomy. The PV/SMV reconstruction with leg vein provides good patency with minimal postoperative lower extremity complications and no increase in late mortality. The lower extremities should be routinely included in the operative field of patients undergoing pancreaticoduodenectomy.
胰腺肿瘤患者可能存在门静脉（PV）和/或肠系膜上静脉（SMV）侵犯。在这种情况下，下肢静脉可以为 PV/SMV 重建提供自体移植物。然而，目前关于 PV/SMV 重建技术、此类重建的通畅性以及在胰十二指肠切除术中使用下肢静脉进行 PV/SMV 重建的发病率的数据很少。
34 例患者在胰十二指肠切除术中使用下肢静脉进行 PV/SMV 重建。首选隐静脉进行修补，股静脉进行替换。我们分析了术前影像学检查、重建通畅性、静脉采集发病率和晚期死亡率。
患者的平均年龄为 62.6 岁。所有 34 例患者均行术前计算机断层扫描（CT）成像和/或内镜超声（EUS）检查。34 例患者中有 14 例 CT 或 EUS 扫描显示有 PV/SMV 侵犯，14 例无侵犯，6 例检查结果不确定。25 例患者有随访影像学检查，22 例（88%）重建通畅。15 例患者采用股静脉进行 PV/SMV 替换。其中 7 例术后下肢轻度水肿，随时间推移而缓解；5 例股静脉采集部位出现伤口并发症，其中 3 例需要进行小手术治疗；15 例患者采用大隐静脉进行 PV/SMV 修补，术后无伤口问题，1 例术后下肢轻度水肿。4 例患者采用股静脉进行 PV/SMV 修补，术后无伤口问题，1 例术后下肢轻度水肿。与未行 PV/SMV 重建的胰十二指肠切除术患者相比，Kaplan-Meier 分析显示，两组患者的晚期死亡率无差异。
术前影像学检查可能无法检测出胰十二指肠切除术患者的 PV/SMV 受累情况。下肢静脉进行的 PV/SMV 重建具有良好的通畅性，术后下肢并发症少，晚期死亡率无增加。在进行胰十二指肠切除术时，应常规将下肢纳入手术视野。
