Ferreira Nélio, Oussoultzoglou Elie, Fuchshuber Pascal, Ntourakis Dimitrios, Narita Masato, Rather Mudassir, Rosso Edoardo, Addeo Pietro, Pessaux Patrick, Jaeck Daniel, Bachellier Philippe
Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098 Strasbourg CEDEX, France.
Arch Surg. 2011 Dec;146(12):1375-81. doi: 10.1001/archsurg.2011.688.
A splenic vein (SV)-inferior mesenteric vein (IMV) anastomosis reduces congestion of the stomach and spleen after pancreaticoduodenectomy with resection of the SV-mesenteric vein confluence but carries a risk of left-sided venous hypertension.
Comparative retrospective study.
Department of Digestive Surgery and Transplantation, University of Strasbourg, Strasbourg, France.
From January 1, 2002, to February 28, 2010, 39 patients underwent pancreaticoduodenectomy with resection of the SV-mesenteric vein confluence for pancreatic adenocarcinoma. All patients had a terminoterminal portal vein-superior mesenteric vein anastomosis. The SV blood flow into the portal vein was preserved in 11 patients by reimplantation of the SV into the portal vein. Sixteen patients underwent surgical reconstruction of the SV-IMV confluence by anastomosis (group 1), and in 12 patients the natural SV-IMV confluence was preserved (group 2).
Preoperative and postoperative spleen volume and platelet count.
Demographic characteristics, preoperative tumor staging, pathological outcome, and postoperative complications were comparable in both groups. There was no difference in platelet count between groups 1 and 2 preoperatively (mean [SD], 293.13 [125.37] vs 241.09 [49.12] × 10(3)/μL [to convert to × 10(9)/L, multiply by 1.0], respectively; P = .21) or postoperatively (mean [SD], 231.75 [156.39] vs 164.31 [76.46] × 10(3)/μL, respectively; P = .32). Likewise, no difference was found in the spleen volume preoperatively (mean [SD], 258.96 [179.23] vs 237.31 [122.46] mL, respectively; P = .76) and on postoperative day 15 (mean [SD], 279.08 [158.10] vs 299.12 [153.11] mL, respectively; P = .78).
Early assessment shows that SV-IMV anastomosis is as feasible and as safe as the preservation of a natural SV-IMV confluence in patients undergoing pancreaticoduodenectomy with vascular resection for pancreatic head adenocarcinoma.
在胰十二指肠切除术切除脾静脉（SV）-肠系膜下静脉（IMV）汇合处后，行脾静脉-肠系膜下静脉吻合术可减轻胃和脾脏的充血，但存在左侧静脉高压的风险。
比较性回顾性研究。
法国斯特拉斯堡大学消化外科与移植科。
2002年1月1日至2010年2月28日，39例患者因胰腺腺癌接受了切除SV-肠系膜静脉汇合处的胰十二指肠切除术。所有患者均行门静脉-肠系膜上静脉端端吻合术。11例患者通过将脾静脉重新植入门静脉来保留脾静脉流入门静脉的血流。16例患者通过吻合术对脾静脉-肠系膜下静脉汇合处进行手术重建（第1组），12例患者保留自然的脾静脉-肠系膜下静脉汇合处（第2组）。
术前和术后的脾脏体积及血小板计数。
两组患者的人口统计学特征、术前肿瘤分期、病理结果及术后并发症具有可比性。第1组和第2组术前血小板计数无差异（均值[标准差]分别为293.13[125.37]和241.09[49.12]×10³/μL[换算为×10⁹/L需乘以1.0]；P = 0.21），术后也无差异（均值[标准差]分别为231.75[156.39]和164.31[76.46]×10³/μL；P = 0.32）。同样，术前脾脏体积无差异（均值[标准差]分别为258.96[179.23]和237.31[122.46]mL；P = 0.76），术后第15天也无差异（均值[标准差]分别为279.08[158.10]和299.12[153.11]mL；P = 0.78）。
早期评估表明，对于因胰头腺癌行血管切除的胰十二指肠切除术患者，脾静脉-肠系膜下静脉吻合术与保留自然的脾静脉-肠系膜下静脉汇合处一样可行且安全。
