Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
Ann Surg. 2021 Jul 1;274(1):e36-e44. doi: 10.1097/SLA.0000000000003487.
The aim of this study was to evaluate how often left-sided portal hypertension (LPH) develops and how LPH affects the long-term outcomes of patients with pancreatic cancer treated with pancreaticoduodenectomy (PD) and resection of the portal vein (PV)/superior mesenteric vein (SMV) confluence.
Little is known about LPH after PD with resection of the PV/SMV confluence.
Overall, 536 patients who underwent PD with PV/SMV resection were enrolled. Among them, we mainly compared the SVp group [n=285; the splenic vein (SV) was preserved] and the SVr group (n = 227; the SV was divided and not reconstructed).
The incidence of variceal formation in the SVr group increased until 3 years after PD compared with that in the SVp group (38.7% vs 8.3%, P < 0.001). Variceal bleeding occurred in the SVr group (n = 9: 4.0%) but not in the SVp group (P < 0.001). In the multivariate analysis, the risk factors for variceal formation were liver disease, N factor, conventional PD, middle colic artery resection, and SV division. The only risk factor for variceal bleeding was SV division. The platelet count ratio at 6 months after PD was significantly lower in the SVr group than in the SVp group (0.97 vs 0.82, P < 0.001), and the spleen-volume ratios at 6 and 12 months were significantly higher in the SVr group than in the SVp group (1.38 vs 1.00 and 1.54 vs 1.09; P < 0.001 and P < 0.001, respectively).
PD with SV division causes variceal formation, bleeding, and thrombocytopenia.
本研究旨在评估左侧门静脉高压症（LPH）的发生频率，以及 LPH 如何影响接受胰十二指肠切除术（PD）和门静脉（PV）/肠系膜上静脉（SMV）汇合部切除的胰腺癌患者的长期预后。
关于 PD 合并 PV/SMV 汇合部切除后发生 LPH 的情况知之甚少。
共纳入 536 例行 PD 合并 PV/SMV 切除的患者。其中，我们主要比较了 SVp 组（n=285；保留脾静脉（SV））和 SVr 组（n=227；SV 被切断且未重建）。
与 SVp 组相比，SVr 组 PD 后 3 年内静脉曲张形成的发生率增加（38.7% vs 8.3%，P<0.001）。SVr 组发生静脉曲张出血（n=9：4.0%），但 SVp 组未发生（P<0.001）。多因素分析显示，静脉曲张形成的危险因素为肝病、N 因子、常规 PD、结肠中动脉切除和 SV 切断。静脉曲张出血的唯一危险因素是 SV 切断。PD 后 6 个月时，SVr 组的血小板计数比值明显低于 SVp 组（0.97 比 0.82，P<0.001），6 个月和 12 个月时 SVr 组的脾脏体积比明显高于 SVp 组（1.38 比 1.00 和 1.54 比 1.09；P<0.001 和 P<0.001）。
PD 合并 SV 切断可导致静脉曲张形成、出血和血小板减少。
