Whistance Robert N, Shah Vallari, Grist Emily R, Shearman Clifford P, Pearce Neil W, Odurny Allan, Stedman Brian, Johnson Colin D
Department of Hepatobiliary and Pancreatic Surgery, Southampton General Hospital, UK.
Ann R Coll Surg Engl. 2011 May;93(4):e11-4. doi: 10.1308/003588411X13008915740787.
Pancreaticoduodenectomy is the standard treatment for localised neoplasms of the pancreatic head. The operation can be performed safely in specialist units but good outcome is compromised if postoperative blood flow to the liver and biliary tree is inadequate. Coeliac artery occlusion with blood supply to the liver arising from the superior mesenteric artery via the gastroduodenal artery is difficult to recognise, especially intraoperatively. Recognition of absent hepatic artery pulsation after occlusion of the gastroduodenal artery opens a dilemma: should the resection be abandoned or should vascular reconstruction be undertaken, adding risk to an already complex procedure? We describe two cases with a resectable pancreatic endocrine tumour in which coeliac artery occlusion caused by median arcuate ligament compression was identified from cross-sectional imaging and reconstructions. We highlight two different strategies to correct the vascular insufficiency and allow safe pancreatic resection.
胰十二指肠切除术是胰头局部肿瘤的标准治疗方法。该手术在专业科室可安全进行，但如果术后肝脏和胆管树的血流不足，良好的预后会受到影响。腹腔干闭塞且肝脏血供由肠系膜上动脉经胃十二指肠动脉提供，这很难识别，尤其是在术中。胃十二指肠动脉闭塞后肝动脉搏动消失会带来一个两难困境：是应放弃切除还是应进行血管重建，从而给本就复杂的手术增加风险？我们描述了两例可切除的胰腺内分泌肿瘤病例，通过横断面成像和重建确定了由正中弓状韧带压迫导致的腹腔干闭塞。我们强调了两种不同的策略来纠正血管不足并实现安全的胰腺切除。
