Meurisse Nicolas, Ansart François, Honoré Pierre, De Roover Arnaud
Abdominal and Transplant Surgery Department, University of Liege, CHU Sart Tilman, Liege, Belgium.
Abdominal and Transplant Surgery Department, University of Liege, CHU Sart Tilman, Liege, Belgium.
Int J Surg Case Rep. 2020;74:296-299. doi: 10.1016/j.ijscr.2020.07.046. Epub 2020 Jul 17.
Combined total portal vein (PV) and superior mesenteric artery (SMA) resection during pancreaticoduodenectomy (PD) is a challenging task that is no longer considered as a contra-indication to achieve R0 in borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).
We report a 66-year-old female with BR-PDAC of the head of the pancreas in whom PV and SMA were replaced with a glutaraldehyde-fixed autologous peritoneo-fascial graft (APG) and a splenomesenteric arterial bypass, respectively, during the PD.
When PV venorraphy or end-to-end anastomosis is not feasible, APG conduit, immediately available without extra-incision, does not need postoperative anticoagulation and is associated with a low risk of infection and thrombosis. If fixed in glutaraldehyde, handling, risk of compression when placed intra-peritoneally and long-term patency of the graft are improved.
Glutaraldehyde-fixed APG is a strategy that every surgeon should bear in mind for PV replacement during PD and other HBP surgical procedures, especially if a vascular resection is unforeseen.
在胰十二指肠切除术（PD）期间联合切除门静脉（PV）和肠系膜上动脉（SMA）是一项具有挑战性的任务，在交界可切除（BR）和局部进展期（LA）胰腺导管腺癌（PDAC）中，这不再被视为实现R0切除的禁忌症。
我们报告了一名66岁患有胰头BR-PDAC的女性患者，在PD手术期间，分别用戊二醛固定的自体腹膜筋膜移植物（APG）和脾-肠系膜动脉旁路替代了PV和SMA。
当PV静脉修补术或端端吻合不可行时，APG导管无需额外切口即可立即使用，不需要术后抗凝，且感染和血栓形成风险低。如果用戊二醛固定，移植物的处理、腹腔内放置时的受压风险和长期通畅性都会得到改善。
戊二醛固定的APG是一种每位外科医生在PD及其他肝门部手术期间进行PV置换时都应牢记的策略，尤其是在未预见血管切除的情况下。
