Del Chiaro Marco, Segersvärd Ralf, Rangelova Elena, Coppola Alessandro, Scandavini Chiara Maria, Ansorge Christoph, Verbeke Caroline, Blomberg John
Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
Department of Pathology, Karolinska Institute, Stockholm, Sweden.
J Gastrointest Surg. 2015 Dec;19(12):2264-8. doi: 10.1007/s11605-015-2958-1. Epub 2015 Sep 30.
Pancreatectomy associated with superior mesenteric-portal vein (SMPV) resection is currently considered the standard of care for patients with pancreatic tumors involving the major peripancreatic veins. However, a standard approach for resection and reconstruction is not defined yet. The aim of this study is to analyze the feasibility and short-term results of an original Cattell-Braasch artery-first approach (CBAF) for the resection of SMPV during pancreatectomy. Of 144 pancreatectomies with vascular resection undertaken from 2008 to 2013 at Karolinska University Hospital, 45 (31.2 %) were performed combining a Cattell-Braasch maneuver with an artery-first approach (from 2011 to 2013). The mean patient age was 65.2 years. Thirty-seven (82.2 %) patients underwent pancreatoduodenectomy and 8 (17.8 %) total pancreatectomy. Histology showed pancreatic ductal adenocarcinoma in 42 patients (93.3 %). The median length of the resected SMPV segment was 4.6 cm (range 3-7). In all patients, a direct end-to-end anastomosis was performed without graft interposition. In nine cases (20 %), an arterial resection was also performed. There was no mortality in this series, and the morbidity rate was 35.5 %. Combined CBAF for the resection of SMPV during pancreatectomy seems to be safe and effective. The reconstruction of the resected vessels is possible in many cases without graft interposition, even if the resected vein segment is of considerable length.
与肠系膜上静脉-门静脉（SMPV）切除相关的胰腺切除术目前被认为是治疗累及胰腺周围主要静脉的胰腺肿瘤患者的标准治疗方法。然而，尚未确定切除和重建的标准方法。本研究的目的是分析一种原创的卡特-布腊施动脉优先入路（CBAF）在胰腺切除术中切除SMPV的可行性和短期结果。在卡罗林斯卡大学医院2008年至2013年进行的144例血管切除的胰腺切除术中，45例（31.2%）采用了卡特-布腊施手法结合动脉优先入路（2011年至2013年）。患者平均年龄为65.2岁。37例（82.2%）患者接受了胰十二指肠切除术，8例（17.8%）接受了全胰切除术。组织学检查显示42例（93.3%）为胰腺导管腺癌。切除的SMPV段的中位长度为4.6 cm（范围3 - 7 cm）。所有患者均进行了直接端端吻合，未插入移植物。9例（20%）患者还进行了动脉切除。本系列无死亡病例，发病率为35.5%。在胰腺切除术中联合使用CBAF切除SMPV似乎是安全有效的。即使切除的静脉段长度相当，在许多情况下不插入移植物也可以重建切除的血管。
