保留脾脏的远端胰腺切除术并切除脾血管。是否应依赖胃短动脉？

Spleen-preserving distal pancreatectomy with resection of the splenic vessels. Should one rely on the short gastric arteries?

作者信息

Egorov Vyacheslav Ivanovich, Yashina Nina Ivanovna, Zhurenkova Tatyana Valentinovna, Petukhova Maria Vladimirovna, Starostina Nataliya Sergeyevna, Zarinskaya Svetlana Alekseyevna, Dmitriyeva Kristina Anatolyevna, Shevchenko Tatyana Valentinovna, Petrov Roman Valeryevich

机构信息

Department of Hepatopancreatobiliary Surgery, Vishnevsky Institute of Surgery, Moscow, Russia.

出版信息

JOP. 2011 Sep 9;12(5):445-57.

PMID:21904069

Abstract

CONTEXT

Knowing the collaterals is essential for a spleen-preserving distal pancreatectomy with resection of the splenic vessels.

OBJECTIVE

To ascertain the sources of the blood supply to the spleen after a spleen-preserving distal pancreatectomy with resection of the splenic vessels.

METHODS

Perfusion of the cadaveric left gastric and right gastroepiploic arteries with methylene blue after occlusion of all the arteries except the short gastric arteries (n=10). Intraoperative color Doppler ultrasound was used for the evaluation of the hilar arterial blood flow at distal pancreatectomy (n=23) after 1) clamping of the splenic artery alone, 2) clamping of the splenic and left gastroepiploic arteries and 3) clamping of the splenic and short gastric arteries. CT angiography of the gastric and splenic vessels before and after a spleen-preserving distal pancreatectomy (n=10).

RESULTS

Perfusion of the cadaveric arteries revealed no effective direct or indirect (through the submucous gastric arterial network) communication between the left gastric and the branches of the short gastric arteries. In no case did intraoperative color Doppler ultrasound detect any hilar arterial blood flow after the clamping of the splenic and left gastroepiploic arteries. The clamping of the short gastric arteries did not change the flow parameters. In none of the cases did a post-spleen-preserving distal pancreatectomy with resection of the splenic vessels CT angiography delineate the short gastric vessels supplying the spleen. In all cases, the gastroepiploic arcade was the main arterial pathway feeding the spleen.

CONCLUSION

Experimental, intra- and postoperative instrumental investigations did not show the short gastric arteries to be engaged in the blood supply to the spleen after a spleen-preserving distal pancreatectomy with resection of the splenic vessels. In all cases, the left gastroepiploic artery was the main collateral vessel.

摘要

背景

对于保留脾脏的远端胰腺切除术并切除脾血管而言，了解侧支血管至关重要。

目的

确定保留脾脏的远端胰腺切除术并切除脾血管后脾脏的血液供应来源。

方法

在除胃短动脉外的所有动脉闭塞后，用亚甲蓝灌注尸体的胃左动脉和胃网膜右动脉（n = 10）。在远端胰腺切除术中，于以下情况后使用术中彩色多普勒超声评估肝门动脉血流（n = 23）：1）单独夹闭脾动脉；2）夹闭脾动脉和胃网膜左动脉；3）夹闭脾动脉和胃短动脉。在保留脾脏的远端胰腺切除术前后对胃和脾血管进行CT血管造影（n = 10）。

结果

尸体动脉灌注显示胃左动脉与胃短动脉分支之间不存在有效的直接或间接（通过胃黏膜下动脉网络）交通。在夹闭脾动脉和胃网膜左动脉后，术中彩色多普勒超声在任何情况下均未检测到肝门动脉血流。夹闭胃短动脉未改变血流参数。在所有保留脾脏的远端胰腺切除术并切除脾血管的病例中，CT血管造影均未显示供应脾脏的胃短血管。在所有病例中，胃网膜弓是供应脾脏的主要动脉途径。