Krepline A N, Christians K K, Duelge K, Mahmoud A, Ritch P, George B, Erickson B A, Foley W D, Quebbeman E J, Turaga K K, Johnston F M, Gamblin T C, Evans D B, Tsai S
Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA.
J Gastrointest Surg. 2014 Nov;18(11):2016-25. doi: 10.1007/s11605-014-2635-9. Epub 2014 Sep 17.
Pancreatectomy with venous reconstruction (VR) for pancreatic cancer (PC) is occurring more commonly. Few studies have examined the long-term patency of the superior mesenteric-portal vein confluence following reconstruction.
From 2007 to 2013, patients who underwent pancreatic resection with VR for PC were classified by type of reconstruction. Patency of VR was assessed using surveillance computed tomographic imaging obtained from date of surgery to last follow-up.
VR was performed in 43 patients and included the following: tangential resection with primary repair (7, 16%) or saphenous vein patch (9, 21%); segmental resection with splenic vein division and either primary anastomosis (10, 23%) or internal jugular vein interposition (8, 19%); or segmental resection with splenic vein preservation and either primary anastomosis (3, 7%) or interposition grafting (6, 14%). All patients were instructed to take aspirin after surgery; low molecular weight heparin was not routinely used. An occluded VR was found in four (9%) of the 43 patients at a median follow-up of 13 months; median time to detection of thrombosis in the four patients was 72 days (range 16-238).
Pancreatectomy with VR can be performed with high patency rates. The optimal postoperative pharmacologic therapy to prevent thrombosis requires further investigation.
胰腺癌（PC）行胰腺切除联合静脉重建（VR）术越来越常见。很少有研究探讨重建后肠系膜上静脉-门静脉汇合处的长期通畅情况。
2007年至2013年，对因PC行胰腺切除联合VR术的患者按重建类型进行分类。使用从手术日期至最后一次随访期间获得的监测计算机断层扫描成像评估VR的通畅情况。
43例患者接受了VR术，包括以下类型：切线切除并一期修复（7例，16%）或大隐静脉补片修补（9例，21%）；节段性切除并脾静脉离断，然后行一期吻合（10例，23%）或颈内静脉间置（8例，19%）；或节段性切除并保留脾静脉，然后行一期吻合（3例，7%）或间置移植（6例，14%）。所有患者术后均被要求服用阿司匹林；未常规使用低分子量肝素。43例患者中，4例（9%）在中位随访13个月时发现VR闭塞；4例患者血栓形成的中位检测时间为72天（范围16 - 238天）。
胰腺切除联合VR术可获得较高的通畅率。预防血栓形成的最佳术后药物治疗方法有待进一步研究。
