Takasu Hiroyuki, Kuramoto Yasuyo, Yokoyama Shigekazu, Ota Hideo, Yagi Sasagu, Hisamoto Sawa, Furukawa Soichi, Shimomura Yutaka
Department of Plastic Surgery, Yamaguchi University Hospital, Ube, Japan.
Department of Plastic Surgery, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan.
Plast Reconstr Surg Glob Open. 2021 Feb 15;9(2):e3423. doi: 10.1097/GOX.0000000000003423. eCollection 2021 Feb.
Celiac artery (CA) occlusion, or stenosis, is not uncommon, and most cases are asymptomatic. If the CA is occluded, collateral circulation from the superior mesenteric artery (SMA) is maintained through the pancreaticoduodenal arcade. However, the pancreaticoduodenal arcade is removed if pancreaticoduodenectomy (PD) is performed, which results in ischemia of the liver, stomach, and residual pancreas. Thus, these patients require CA revascularization, which can include antegrade endovascular reconstruction and retrograde reconstruction using vascular anastomosis from the SMA system to the CA system. Both methods carry risks of restenosis or anastomotic thrombosis. We report a technique that involves a combination of both revascularization methods in an 89-year-old man who underwent PD for lower bile duct cancer. Preoperative endovascular stent placement in the CA preserved antegrade blood flow to the liver, and intraoperative vascular anastomosis of the jejunal artery and right gastroepiploic artery achieved retrograde blood flow. Although we confirmed both stent and anastomosis patency and blood circulation in our case, obstruction of 1 of these revascularization pathways would not likely lead to ischemia of the liver. Thus, our 2-way revascularization technique for managing celiac artery stenosis during PD may reduce the risk of organ ischemia.
腹腔干（CA）闭塞或狭窄并不少见，且大多数病例无症状。如果CA闭塞，肠系膜上动脉（SMA）的侧支循环通过胰十二指肠动脉弓得以维持。然而，若进行胰十二指肠切除术（PD），胰十二指肠动脉弓会被切除，这会导致肝脏、胃和残余胰腺缺血。因此，这些患者需要进行CA血管重建，可包括顺行性血管腔内重建以及使用从SMA系统到CA系统的血管吻合进行逆行重建。这两种方法都有再狭窄或吻合口血栓形成的风险。我们报告了一种技术，该技术在一名因低位胆管癌接受PD手术的89岁男性患者中联合应用了这两种血管重建方法。术前在CA内放置血管内支架保留了肝脏的顺行血流，术中空肠动脉与右胃网膜动脉的血管吻合实现了逆行血流。尽管在我们的病例中证实了支架和吻合口通畅以及血液循环，但这些血管重建途径中的一条发生阻塞不太可能导致肝脏缺血。因此，我们在PD期间处理腹腔干狭窄的双向血管重建技术可能会降低器官缺血的风险。
