Zhiying Yang, Haidong Tan, Xiaolei Liu, Yongliang Sun, Shuang Si, Liguo Liu, Li Xu, Atyah Manar
Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China.
Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China.
J Surg Res. 2017 Oct;218:226-231. doi: 10.1016/j.jss.2017.05.090. Epub 2017 Jun 21.
Tumor invasion or adherence to the portal vein-superior mesenteric vein (PV/SMV) may be encountered during pancreatic surgery. In such cases, venous resection and reconstruction might be required for complete resection of the tumor. We report an innovative technique in which the graft for PV/SMV reconstruction was made with the falciform ligament.
Between May 2011 and July 2016, PV/SMV reconstruction with a falciform ligament graft was performed in 10 cases during pancreatectomy. Among these cases, including six cases with a patch graft and four cases with a conduit graft. Retrospective reviews of medical records and radiologic studies were performed.
Ten patients with pancreatobiliary cancer underwent en bloc tumor resection with concurrent PV/SMV resection and reconstruction with a falciform ligament graft. There were six males and four females, and the mean age was 65.3 ± 9.4 (48-80) y. Using Doppler ultrasound examination, all 10 grafts were shown to be patent at postoperative 2 wk. However, occlusion was found in one case with conduit graft and stenosis in the other three cases with conduit graft using enhanced computed tomography at postoperative 2 mo. Complete patency was shown in three of six cases with patch graft and stenosis in the other three cases at 2 mo after the operation. Although occlusion or stenosis of the grafts was observed, no severe adverse events occurred, and normal liver function was discovered in all 10 cases at postoperative 2 mo.
Falciform ligament grafts might be considered for reconstruction of PV/SMV in the absence of appropriate vascular grafts.
胰腺手术中可能会遇到肿瘤侵犯或粘连门静脉-肠系膜上静脉（PV/SMV）的情况。在此类病例中，可能需要进行静脉切除和重建以实现肿瘤的完整切除。我们报告一种创新技术，即用镰状韧带制作PV/SMV重建的移植物。
2011年5月至2016年7月期间，10例患者在胰腺切除术中采用镰状韧带移植物进行PV/SMV重建。其中，包括6例补片移植和4例管道移植。对病历和影像学研究进行回顾性分析。
10例胰胆管癌患者接受了肿瘤整块切除，同时进行PV/SMV切除并用镰状韧带移植物重建。男性6例，女性4例，平均年龄65.3±9.4（48 - 80）岁。术后2周，通过多普勒超声检查显示所有10个移植物均通畅。然而，术后2个月增强CT检查发现1例管道移植病例移植物闭塞，另外3例管道移植病例移植物狭窄。术后2个月，6例补片移植病例中有3例移植物完全通畅，另外3例狭窄。尽管观察到移植物闭塞或狭窄，但未发生严重不良事件，术后2个月所有10例患者肝功能均正常。
在没有合适血管移植物的情况下，可考虑使用镰状韧带移植物重建PV/SMV。
