Khatkov Igor E, Izrailov Roman E, Khisamov Arthur A, Tyutyunnik Pavel S, Fingerhut Abraham
Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia.
Chair of Faculty Surgery №2, Moscow State University of Medicine and Dentistry, Moscow, Russia.
Surg Endosc. 2017 Mar;31(3):1488-1495. doi: 10.1007/s00464-016-5115-3. Epub 2016 Jul 21.
Laparoscopic pancreatoduodenectomy (LPD) with concomitant resection of major portal vessels has recently emerged as feasible and safe, with similar morbidity and mortality as well as oncologic outcome compared with patients undergoing open PD with major vascular resection.
Of a consecutive series of 133 LPD, eight patients underwent concomitant superior mesenteric vein/portal vein (SMV/PV) resection and reconstruction with the intent of achieving a R0 resection.
Four of these eight patients had tangential resection followed by lateral wall repair with Prolene 4.0. One patient had tangential resection with patch reconstruction. Three patients had circular venous resection: One had end-to-end primary venous reconstruction, and two patients had a prosthetic vascular graft interposition. There was no operative mortality. The SMV/PV was patent in all patients postoperatively on ultrasound Doppler or CT scans. Two patients (who underwent circular venous resection) had postoperative complications. One 77-year-old patient with preexisting cardiovascular disease died of heart failure on postoperative day 2, while another (undergoing prosthetic graft reconstruction) had postoperative bilioenteric anastomotic dehiscence and underwent immediate re-laparoscopy for repair.
In our experience, LPD with concomitant major venous resection is feasible even in cases of longitudinal venous invasion. Further studies are needed to evaluate the role of laparoscopy in borderline pancreatic cancer.
腹腔镜胰十二指肠切除术（LPD）联合主要门静脉血管切除近来已被证实是可行且安全的，与接受开放性胰十二指肠切除术联合主要血管切除的患者相比，其发病率、死亡率以及肿瘤学结局相似。
在连续的133例LPD病例中，8例患者接受了肠系膜上静脉/门静脉（SMV/PV）联合切除及重建，目的是实现R0切除。
这8例患者中，4例行切线切除，随后用4.0普理灵缝线进行侧壁修补。1例行切线切除并补片重建。3例行环状静脉切除：1例行端端原发性静脉重建，2例行人工血管移植介入。无手术死亡病例。术后超声多普勒或CT扫描显示所有患者的SMV/PV均通畅。2例（行环状静脉切除的患者）出现术后并发症。1例77岁的老年患者，术前患有心血管疾病，术后第2天死于心力衰竭；另1例（行人工血管移植重建的患者）术后出现胆肠吻合口裂开，随即接受再次腹腔镜修补术。
根据我们的经验，即使存在纵向静脉侵犯，LPD联合主要静脉切除也是可行的。需要进一步研究来评估腹腔镜在临界性胰腺癌中的作用。
