Malinka T, Klein F, Denecke T, Pelzer U, Pratschke J, Bahra M
Department of Surgery, Charité Campus Mitte and Charité Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Department of Radiology, Charité Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
HPB Surg. 2018 Oct 1;2018:2943879. doi: 10.1155/2018/2943879. eCollection 2018.
Since local tumor infiltration to the mesenteric-portal axis might represent a challenging assignment for curative intended resectability during pancreatic surgery, appropriate techniques for venous reconstruction are essential. In this study, we acknowledge the falciform ligament as a feasible and convenient substitute for mesenteric and portal vein reconstruction with high reliability and patency for local advanced pancreatic tumor.
A retrospective single-center analysis. Between June 2017 and January 2018, a total of eleven consecutive patients underwent pancreatic resections with venous reconstruction using falciform ligament. Among them, venous resection was performed in nine cases by wedge and in two cases by full segment. Patency rates and perioperative details were reviewed.
Mean clamping time of the mesenteric-portal blood flow was 34 min, while perioperative mortality rate was 0%. By means of Duplex ultrasonography, nine patients were shown to be patent on the day of discharge, while two cases revealed an entire occlusion of the mesenteric-portal axis. Orthograde flow demonstrated a mean value of 34 cm/s. All patent grafts on discharge revealed persistent patency within various follow-up assessments.
The falciform ligament appears to be a feasible and reliable autologous tissue for venous blood flow reconstruction with high postoperative patency. Especially the possibility of customizing graft dimensions to the individual needs based on local findings allows an optimal size matching of the conduit. The risk of stenosis and/or segmental occlusion may thus be further reduced.
由于局部肿瘤浸润至肠系膜-门静脉轴可能给胰腺癌手术中旨在实现根治性切除的操作带来挑战，因此合适的静脉重建技术至关重要。在本研究中，我们认可镰状韧带是一种可行且便捷的替代物，可用于局部进展期胰腺癌的肠系膜和门静脉重建，具有较高的可靠性和通畅率。
一项回顾性单中心分析。在2017年6月至2018年1月期间，共有11例连续患者接受了使用镰状韧带进行静脉重建的胰腺切除术。其中，9例采用楔形静脉切除术，2例采用全段静脉切除术。回顾了通畅率和围手术期细节。
肠系膜-门静脉血流的平均阻断时间为34分钟，围手术期死亡率为0%。通过双功超声检查，9例患者在出院当天显示血管通畅，而2例显示肠系膜-门静脉轴完全闭塞。顺行血流的平均值为34厘米/秒。所有出院时通畅的移植物在各种随访评估中均保持通畅。
镰状韧带似乎是一种可行且可靠的自体组织，用于静脉血流重建，术后通畅率高。特别是根据局部情况将移植物尺寸定制以满足个体需求的可能性，可使管道实现最佳尺寸匹配。因此，狭窄和/或节段性闭塞的风险可能会进一步降低。
