一种将下腔静脉固定于十二指肠尾侧的技术：腹膜后淋巴结清扫术后下腔静脉滤器支柱穿透十二指肠——肠系膜入路的实用性
A technique for taping inferior vena cava caudal to the duodenum: duodenal penetration by IVC filter strut after retroperitoneal lymph node dissection-usefulness of the mesenteric approach.
作者信息
Shimizu Takayuki, Kubota Keiichi, Suzuki Takashi, Matsumoto Takatsugu, Shiraki Takayuki, Sakuraoka Yuhki, Mori Shozo, Iso Yukihiro, Kato Masato, Ishizuka Mitsuru, Aoki Taku
机构信息
Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
出版信息
Surg Case Rep. 2019 Apr 24;5(1):69. doi: 10.1186/s40792-019-0626-5.
BACKGROUND
Although an inferior vena cava (IVC) filter is used for preventing pulmonary thromboembolism (PTE) in patients with deep vein thrombosis, IVC filter penetration in the duodenum is a rare complication.
CASE PRESENTATION
A 35-year-old man had previously undergone retroperitoneal lymph node dissection (RPLND) for testicular cancer and IVC filter placement for prevention of PTE. Esophagogastroduodenoscopy (EGD) for his epigastric pain revealed penetration of the IVC filter in the duodenum. The IVC filter was retrieved through cavotomy, and the duodenal penetration was repaired using EGD clipping. Although it was difficult to mobilize the duodenum due to adhesion resulting from RPLND, the use of a mesenteric approach enabled encircling of the IVC caudal to the duodenum. The mesenteric approach is useful and safe for taping the IVC caudal to the duodenum in cases where it is difficult to mobilize the duodenum.
CONCLUSION
IVC taping using the mesenteric approach allowed safe retrieval of the IVC filter after RPLND without postoperative complications.
背景
尽管下腔静脉（IVC）滤器用于预防深静脉血栓形成患者的肺血栓栓塞症（PTE），但IVC滤器穿透十二指肠是一种罕见的并发症。
病例报告
一名35岁男性曾因睾丸癌接受腹膜后淋巴结清扫术（RPLND）并放置IVC滤器以预防PTE。因上腹部疼痛进行的食管胃十二指肠镜检查（EGD）显示IVC滤器穿透十二指肠。通过腔切开术取出IVC滤器，并使用EGD夹闭修复十二指肠穿孔。尽管由于RPLND导致的粘连难以移动十二指肠，但采用肠系膜入路能够在十二指肠尾侧环绕IVC。在难以移动十二指肠的情况下，肠系膜入路对于在十二指肠尾侧结扎IVC是有用且安全的。
结论
采用肠系膜入路进行IVC结扎，使得RPLND后能够安全取出IVC滤器且无术后并发症。
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