Leon-Takahashi Alberto Mitsuo, Gomez-Pedraza Antonio, Cruz-Rodriguez Antonio, Ruiz-Molina Juan Manuel, Padilla-Rosciano Alejandro, Herrera-Gomez Angel
Division of Gastroenterology, National Institute of Cancer, Mexico City, Mexico ; San Fernando Avenue #22. Sector XVI, Tlalpan, Mexico City, 14080 Mexico.
Division of Gastroenterology, National Institute of Cancer, Mexico City, Mexico.
Indian J Surg. 2013 Jun;75(Suppl 1):247-9. doi: 10.1007/s12262-012-0655-9. Epub 2012 Jul 5.
Advanced-stage gastrointestinal tumors are aggressive and frequently invade blood vessels. Advances in endovascular surgery can repair blood vessels that may be infiltrated by a tumor. Currently there are many materials to do this, as the use of prostheses or implants and patches. In Mexico, the bovine pericardium preserved with glutaraldehyde has been used to treat incisional, inguinal, and diaphragmatic hernias and repair vascular defects with good results, low cost, and no allergic reaction from the patient. We report the case of a 47-year-old man, with a history of smoking and alcoholism, diagnosed with pancreatic adenocarcinoma. The tumor, with the use of endoscopic ultrasound, showed direct contact with the portal vein without invading the confluence of the mesenteric vein. During exploratory laparotomy, a tumor attached to the head of the pancreas of 4 cm × 4 cm was found, with tumor invasion of 1 cm × 2 cm on the outer sidewall of the portal vein. We performed pylorus-preserving pancreatoduodenectomy and tumor resection of the portal vein wall with placement of glutaraldehyde-preserved bovine pericardium patch to repair it. The intraoperative and immediate postoperative period arose without complications. The patient was discharged with good result and is currently under surveillance. We report this case to show a successful result using glutaraldehyde-preserved bovine pericardium to close vascular defects after resection of the tumor secondary to vascular invasion.
晚期胃肠道肿瘤具有侵袭性,常侵犯血管。血管内手术的进展能够修复可能被肿瘤浸润的血管。目前有许多材料可用于此,比如使用假体、植入物和补片。在墨西哥,用戊二醛保存的牛心包已被用于治疗切口疝、腹股沟疝和膈疝,以及修复血管缺损,效果良好,成本低廉,且患者无过敏反应。我们报告一例47岁男性病例,有吸烟和酗酒史,诊断为胰腺腺癌。经内镜超声检查,肿瘤与门静脉直接接触,但未侵犯肠系膜静脉汇合处。在剖腹探查术中,发现一个附着于胰头的4厘米×4厘米肿瘤,门静脉外侧壁有1厘米×2厘米的肿瘤浸润。我们实施了保留幽门的胰十二指肠切除术,并切除门静脉壁肿瘤,同时放置用戊二醛保存的牛心包补片进行修复。术中及术后即刻均未出现并发症。患者出院时情况良好,目前正在接受随访。我们报告此病例是为了展示使用戊二醛保存的牛心包修复因血管侵犯而切除肿瘤后的血管缺损所取得的成功结果。