Homsy K, Paquay J-L, Farghadani H
a Department of General Surgery , Cliniques Universitaires Saint Luc , Brussels , Belgium.
b Department of Cardiology , Clinique Saint Joseph , Arlon , Belgium.
Acta Chir Belg. 2019 Jun;119(3):186-188. doi: 10.1080/00015458.2018.1430219. Epub 2018 Feb 20.
Pancreatic cancer is a rare disease with a high mortality rate, for which complete surgical resection, when possible, is the preferred therapeutic. Pancreaticoduodenectomy represents the surgical technique of choice. Abdominal surgeons can be faced with the challenge of patients with a history of coronary artery bypass graft in which the right gastro-epiploic artery is used.
We report the case of a patient with an adenocarcinoma of the pancreatic head, stage IIA, having previously undergone a triple coronary artery bypass, one of which being a right gastro-epiploic graft. Our challenge was underlined by the necessity of a complete oncological resection through a cephalic pancreaticoduodenectomy while preserving the necessary cardiac perfusion via the right gastro-epiploic artery.
We have been able to preserve a right gastro-epiploic artery as a coronary bypass during a cephalic pancreaticoduodenectomy for a cephalic pancreatic adenocarcinoma. We have successfully been able to preserve and re-implant the right gastro-epiploic artery to the origin of the gastroduodenal artery while insuring R0 resection of the tumor. A coronary artery bypass using the right gastro-epiploic artery should therefore not be considered as an obstacle to a Whipple's procedure if total oncological resection is obtainable.
胰腺癌是一种罕见但死亡率很高的疾病，若有可能，完整的手术切除是首选治疗方法。胰十二指肠切除术是首选的手术技术。腹部外科医生可能会面临曾接受冠状动脉搭桥手术且使用了胃网膜右动脉的患者所带来的挑战。
我们报告一例IIA期胰头腺癌患者，该患者此前接受过三次冠状动脉搭桥手术，其中一次使用了胃网膜右动脉。我们面临的挑战在于，既要通过胰头十二指肠切除术进行完整的肿瘤切除，又要通过胃网膜右动脉维持必要的心脏灌注。
我们成功地在胰头十二指肠切除术中保留了胃网膜右动脉作为冠状动脉搭桥血管，用于治疗胰头腺癌。我们成功地将胃网膜右动脉保留并重新植入到胃十二指肠动脉起始处，同时确保了肿瘤的R0切除。因此，如果能够实现肿瘤的完整切除，使用胃网膜右动脉进行的冠状动脉搭桥不应被视为Whipple手术的障碍。
