脾静脉切除的胰十二指肠切除术中左侧门脉高压预测。

Sinistral Portal Hypertension Prediction During Pancreatoduodenectomy With Splenic Vein Resection.

机构信息

Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

Department of Diagnostic Imaging, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

出版信息

J Surg Res. 2021 Mar;259:509-515. doi: 10.1016/j.jss.2020.10.005. Epub 2020 Nov 5.

DOI:10.1016/j.jss.2020.10.005

PMID:33160633

Abstract

BACKGROUND

Pancreaticoduodenectomy with porto-mesenterico-splenic confluence resection can cause sinistral portal hypertension (SPH), which may lead to gastrointestinal bleeding. Nevertheless, it remains difficult to predict SPH development during surgery. The aim of this study is to assess the feasibility of measuring splenic vein (SV) pressure to predict SPH.

METHODS

The patients who underwent pancreaticoduodenectomy with porto-mesenterico-splenic confluence resection between January 2016 and December 2017 were included in this study. SV pressure was measured before SV clamping (SVP1) and after SV clamping (SVP2). SPH was defined as varicose vein formation detected by follow-up computed tomography. Incidence of SPH was assessed in patients who had no SV drainage after surgery.

RESULTS

SV pressure was measured in 41 patients. Among them, 24 had no SV drainage (13 patients had occluded SV reconstruction, and 11 had SV ligation without an attempt at reconstruction) and were included for the analysis. SPH was observed in 16 of 24 patients (67%). The median ΔSVP (SPV2-SVP1) in patients with SPH was higher than that in patients without SPH (13.5 mmHg versus 7.5 mmHg, P = 0.0237). Most patients with SVP2 >20 mmHg (12/14 [86%]) or ΔSVP >10 mmHg (10/11 [91%]) developed SPH.

CONCLUSIONS

For the patients with SV resection, high SV pressure after clamping (≥20 mmHg) and a large SV pressure difference (≥10 mmHg) before and after clamping are feasible indication criteria for SV reconstruction to prevent SPH.

摘要

背景

胰十二指肠切除术联合门静脉肠系膜脾静脉汇合处切除术可导致左侧门静脉高压症（SPH），可能导致胃肠道出血。然而，在手术过程中预测 SPH 的发展仍然很困难。本研究旨在评估测量脾静脉（SV）压力预测 SPH 的可行性。

方法

本研究纳入 2016 年 1 月至 2017 年 12 月期间行胰十二指肠切除术联合门静脉肠系膜脾静脉汇合处切除术的患者。在 SV 夹闭前（SVP1）和夹闭后（SVP2）测量 SV 压力。SPH 定义为术后随访 CT 检测到静脉曲张形成。评估术后无 SV 引流患者 SPH 的发生率。

结果

41 例患者测量了 SV 压力。其中 24 例无 SV 引流（13 例 SV 重建受阻，11 例 SV 结扎未尝试重建）纳入分析。24 例患者中有 16 例（67%）出现 SPH。有 SPH 的患者的 SV 压差值（SVP2-SVP1）中位数高于无 SPH 的患者（13.5mmHg 比 7.5mmHg，P=0.0237）。大多数 SVP2＞20mmHg（12/14[86%]）或 SV 压差值＞10mmHg（10/11[91%]）的患者出现 SPH。