胰十二指肠切除术中用于肠系膜上静脉-门静脉重建的人工血管移植：一项回顾性多中心研究
Prosthetic graft for superior mesenteric-portal vein reconstruction in pancreaticoduodenectomy: a retrospective, multicenter study.
作者信息
Liao Kai, Wang Huaizhi, Chen Qilong, Wu Zheng, Zhang Leida
机构信息
Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China.
出版信息
J Gastrointest Surg. 2014 Aug;18(8):1452-61. doi: 10.1007/s11605-014-2549-6. Epub 2014 Jun 11.
BACKGROUND
The use of prosthetic grafts for superior mesenteric-portal vein reconstruction (SMPVR) after pancreaticoduodenectomy (PD) with venous resection remains controversial. We evaluated the effectiveness and safety of using polytetrafluoroethylene (PTFE) interposition grafts for SMPVR after PD.
METHODS
We identified 76 patients who underwent PD with segmental vein resection for pancreatic head and periampullary neoplasms at three centers between January 2007 and June 2012. The venous reconstruction technique depended on the length of venous involvement. Forty-two and 34 patients underwent SMPVR with primary anastomosis and SMPVR with PTFE interposition grafts, respectively. The postoperative morbidity, mortality, and patency were compared. For the patients with pancreatic ductal adenocarcinoma (n = 65), survival was compared between the SMPVR with primary anastomosis (n = 36) and SMPVR with PTFE interposition graft groups (n = 29).
RESULTS
Patients undergoing SMPVR with PTFE grafts had larger tumor sizes (3.4 ± 0.9 cm, 2.9 ± 0.9 cm, P = 0.016), longer operative durations (492.9 ± 107.5 min, 408.8 ± 78.8 min, P < 0.001), and greater blood loss (986.8 ± 884.5 ml, 616.7 ± 485.5 ml, P = 0.040) compared to those undergoing SMPVR with primary anastomosis. However, 30-day postoperative morbidity and mortality did not differ (29.4 and 2.9 %, respectively, for PTFE grafts and 33.3 and 7.1 %, respectively, for primary anastomosis). There were no cases of graft infection. The estimated cumulative patency of SMPVR 6 and 12 months after surgery did not differ (87.9 and 83.5 % after PTFE grafts, respectively, and 94.4 and 86.4 % after primary anastomosis, respectively). For patients who underwent surgery for pancreatic ductal adenocarcinoma, there were no significant differences in the median survival time (11 vs. 12 months) or the 1-, 2-, and 3-year survival rates (35.7, 12.5, and 4.2 vs. 36.4, 17.3, and 8.7 %, respectively) for the PTFE and primary anastomosis groups.
CONCLUSIONS
PTFE grafts could provide a safe and effective option for venous reconstruction after PD in patients with segmental vein resection.
背景
在胰十二指肠切除术（PD）后行静脉切除时，使用人工血管进行肠系膜上静脉-门静脉重建（SMPVR）仍存在争议。我们评估了使用聚四氟乙烯（PTFE）人工血管行SMPVR在PD后的有效性和安全性。
方法
我们确定了2007年1月至2012年6月期间在三个中心接受PD并因胰头和壶腹周围肿瘤行节段性静脉切除的76例患者。静脉重建技术取决于静脉受累的长度。42例和34例患者分别接受了一期吻合的SMPVR和PTFE人工血管植入的SMPVR。比较了术后发病率、死亡率和通畅率。对于胰腺导管腺癌患者（n = 65），比较了一期吻合的SMPVR组（n = 36）和PTFE人工血管植入组（n = 29）的生存率。
结果
与一期吻合的SMPVR患者相比，接受PTFE人工血管植入的SMPVR患者肿瘤更大（3.4±0.9 cm，2.9±0.9 cm，P = 0.016），手术时间更长（492.9±107.5分钟，408.8±78.8分钟，P < 0.001），失血量更大（986.8±884.5 ml，616.7±485.5 ml，P = 0.040）。然而，术后30天的发病率和死亡率没有差异（PTFE人工血管组分别为29.4%和2.9%，一期吻合组分别为33.3%和7.1%）。没有人工血管感染病例。术后6个月和12个月SMPVR的估计累积通畅率没有差异（PTFE人工血管组分别为87.9%和83.5%，一期吻合组分别为94.4%和86.4%）。对于接受胰腺导管腺癌手术的患者，PTFE组和一期吻合组的中位生存时间（11个月对12个月）或1年、2年和3年生存率（分别为35.7%、12.5%和4.2%对36.4%、17.3%和8.7%）没有显著差异。
结论
对于行节段性静脉切除的PD患者，PTFE人工血管可为静脉重建提供一种安全有效的选择。
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