Nakayama Yusuke, Sugimoto Motokazu, Kobayashi Tatsushi, Gotohda Naoto, Takahashi Shinichiro, Kusumoto Masahiko, Konishi Masaru
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba 277-8577, Japan.
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba 277-8577, Japan.
HPB (Oxford). 2018 Jan;20(1):49-56. doi: 10.1016/j.hpb.2017.08.019. Epub 2017 Sep 14.
The aim of this study was to investigate the impact of pancreaticoduodenal arcade (PDA) dilation on postoperative outcomes after pancreaticoduodenectomy.
Consecutive patients submitted to pancreaticoduodenectomy between 2008 and 2016 underwent preoperative multi-detector computed tomography, the images of which were re-reviewed. The patients were categorized according to the grade of PDA dilation into 3 groups (remarkably-dilated, slightly-dilated, and non-dilated).
Among the 443 patients, 25 patients (5.6%) were categorized as remarkably-dilated PDA and 24 patients (5.4%) as having slightly-dilated PDA. The patients with remarkably-dilated PDA had undergone pancreaticoduodenectomy with additional surgical maneuvers to restore celiac arterial flow as needed, and had an uneventful postoperative recovery relative to those with non-dilated PDA. In contrast, patients with slightly-dilated PDA underwent only pancreaticoduodenectomy without additional surgical maneuvers, and developed clinically relevant postoperative pancreatic fistula (POPF) more frequently than those with non-dilated PDA (42% vs. 21%, P = 0.021). Moreover, slightly-dilated PDA was shown to be an independent risk factor for clinically relevant POPF (odds ratio = 2.719, P = 0.042).
For patients with PDA dilation requiring pancreaticoduodenectomy, a preoperative evaluation of the vascular anatomy, intraoperative assessment of the celiac arterial flow, and additional surgical maneuvers might be necessary to reduce the risk of postoperative complications.
本研究旨在探讨胰十二指肠动脉弓（PDA）扩张对胰十二指肠切除术后结局的影响。
对2008年至2016年间接受胰十二指肠切除术的连续患者进行术前多排螺旋CT检查，并对图像进行重新评估。根据PDA扩张程度将患者分为3组（显著扩张、轻度扩张和未扩张）。
在443例患者中，25例（5.6%）被归类为PDA显著扩张，24例（5.4%）为PDA轻度扩张。PDA显著扩张的患者在必要时接受了胰十二指肠切除术及额外的手术操作以恢复腹腔动脉血流，与PDA未扩张的患者相比，术后恢复顺利。相比之下，PDA轻度扩张的患者仅接受了胰十二指肠切除术，未进行额外的手术操作，其临床相关术后胰瘘（POPF）的发生率高于PDA未扩张的患者（42%对21%，P = 0.021）。此外，PDA轻度扩张被证明是临床相关POPF的独立危险因素（比值比 = 2.719，P = 0.042）。
对于需要进行胰十二指肠切除术的PDA扩张患者，术前评估血管解剖结构、术中评估腹腔动脉血流以及采取额外的手术操作可能有助于降低术后并发症的风险。
