胰头十二指肠切除术联合门静脉/肠系膜上静脉汇合部切除术后的左侧门脉高压症：日本肝胆胰外科学会的项目研究。
Left-sided Portal Hypertension After Pancreaticoduodenectomy With Resection of the Portal Vein/Superior Mesenteric Vein Confluence in Patients With Pancreatic Cancer: A Project Study by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.
机构信息
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan.
Second Department of Surgery, Wakayama Medical University, Wakayama, Japan.
出版信息
Ann Surg. 2021 Jul 1;274(1):e36-e44. doi: 10.1097/SLA.0000000000003487.
OBJECTIVE
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.
SUMMARY BACKGROUND DATA
Little is known about LPH after PD with resection of the PV/SMV confluence.
METHODS
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).
RESULTS
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).
CONCLUSIONS
PD with SV division causes variceal formation, bleeding, and thrombocytopenia.
目的
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。
背景资料概要
关于 PD 合并 PV/SMV 汇合部切除后发生 LPH 的情况知之甚少。
方法
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）。
结果
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）。
结论
PD 合并 SV 切断可导致静脉曲张形成、出血和血小板减少。
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