Zhao Xin, Li Li-Xin, Fan Hua, Kou Jian-Tao, Li Xian-Liang, Lang Ren, He Qiang
Department of Hepatobiliary and Pancreatosplenic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.
J Int Med Res. 2016 Dec;44(6):1339-1348. doi: 10.1177/0300060516665708. Epub 2016 Nov 10.
Objective The results of segmental venous resection (VR) combined with pancreatoduodenectomy (PD) are controversial but may be promising. Few studies have described reconstruction of the portal/superior mesenteric vein (PV/SMV) with the iliac vein harvested from donation after cardiac death (DCD). Methods From January 2014 to April 2016, PD combined with segmental excision of the PV/SMV (VR group) was performed in 21 patients with adenocarcinoma of the head of the pancreas (ADHP). The authors established a new technique of venous reconstruction using the iliac vein from DCD and analysed patients' long-term survival. Results The tumour dimensions and tumour staging were greater and the operation time was longer in the VR than PD group; however, no differences in the resection degree, blood loss, complications, reoperation rate, or mortality rate were found. The median survival was similar between the VR and PD groups. The long-term patency of the donor iliac vein was 90%. The degree of resection was a strong predictor of long-term survival. Conclusion Segmental PV/SMV resection combined with PD is applicable to selective patients with venous invasion by ADHP if R0 resection has probably been achieved. An iliac vein obtained by DCD provides an effective graft for venous reconstruction.
目的 节段性静脉切除（VR）联合胰十二指肠切除术（PD）的结果存在争议，但可能很有前景。很少有研究描述利用心脏死亡后供体（DCD）获取的髂静脉重建门静脉/肠系膜上静脉（PV/SMV）。方法 2014年1月至2016年4月，对21例胰腺头部腺癌（ADHP）患者实施了PD联合PV/SMV节段性切除（VR组）。作者建立了一种使用DCD髂静脉进行静脉重建的新技术，并分析了患者的长期生存情况。结果 VR组的肿瘤大小和肿瘤分期比PD组更大，手术时间更长；然而，在切除程度、失血量、并发症、再次手术率或死亡率方面未发现差异。VR组和PD组的中位生存期相似。供体髂静脉的长期通畅率为90%。切除程度是长期生存的有力预测指标。结论 如果可能实现R0切除，节段性PV/SMV切除联合PD适用于ADHP静脉侵犯的选择性患者。DCD获取的髂静脉为静脉重建提供了有效的移植物。
