Gyoten Kazuyuki, Mizuno Shugo, Nagata Motonori, Ogura Toru, Usui Masanobu, Isaji Shuji
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
World J Surg. 2017 Aug;41(8):2111-2120. doi: 10.1007/s00268-017-3916-8.
In pancreaticoduodenectomy (PD) with resection of portal vein (PV)/superior mesenteric vein (SMV) confluence, the splenic vein (SV) division may cause left-sided portal hypertension (LPH).
The 88 pancreatic ductal adenocarcinoma patients who underwent PD with PV/SMV resection after chemoradiotherapy were classified into three groups: both SV and splenic artery (SA) were preserved in Group A (n = 16), SV was divided and SA was preserved in Group B (n = 58), and both SV and SA were divided in Group C (n = 14). We evaluated the influence of resection of SV and/or SA on LPH after PD with resection of PV/SMV confluence.
The incidence of postoperative varices in Groups A, B and C was 6.3, 67.2 and 38.5%, respectively (p < 0.001), and variceal bleeding occurred only in Group B (n = 4: 6.8%). In multivariate analysis, Group B was the only significant risk factor for the development of postoperative varices (Groups B vs. A: odds ratio = 39.6, p = 0.001, Groups C vs. A: odds ratio = 8.75, p = 0.066). The platelet count ratio at 6 months after operation comparing to preoperative value was 0.93, 0.73 and 1.09 in Groups A, B and C, respectively (Groups B vs. C: p < 0.05), and spleen volume ratio at 6 months was 1.00, 1.37 and 0.96 in Groups A, B and C, respectively (Groups B vs. A and C: p < 0.01 and p < 0.05).
In PD with resection of PV-SMV confluence, the SV division causes LPH, but the concomitant division of SV and SA may attenuate it.
在胰十二指肠切除术（PD）中，若切除门静脉（PV）/肠系膜上静脉（SMV）汇合处，脾静脉（SV）离断可能导致左侧门静脉高压（LPH）。
88例接受放化疗后行PV/SMV切除的胰腺导管腺癌患者被分为三组：A组（n = 16）保留SV和脾动脉（SA）；B组（n = 58）离断SV并保留SA；C组（n = 14）离断SV和SA。我们评估了在PV/SMV汇合处切除术后，SV和/或SA切除对LPH的影响。
A、B、C组术后静脉曲张发生率分别为6.3%、67.2%和38.5%（p < 0.001），且仅B组发生了静脉曲张破裂出血（n = 4：6.8%）。多因素分析显示，B组是术后静脉曲张发生的唯一显著危险因素（B组与A组比较：比值比 = 39.6，p = 0.001；C组与A组比较：比值比 = 8.75，p = 0.066）。术后6个月，A、B及C组的血小板计数与术前值的比值分别为0.93、0.73和1.09（B组与C组比较：p < 0.05），6个月时A、B及C组的脾脏体积与术前值的比值分别为1.00、1.37和0.96（B组与A组及C组比较：p < 0.01和p < 0.05）。
在切除PV - SMV汇合处的PD手术中，SV离断会导致LPH，但SV与SA同时离断可能会减轻LPH。
