在局部进展期胰腺癌中，通过分叉同种异体静脉重建脾-肠系膜-门静脉汇合以避免左侧门脉高压：一种可行的方法。

Reconstructing spleno-mesenterico-portal cofluence by bifurcated allogeneic vein in local advanced pancreatic cancer-a feasible method to avoid left-sided portal hypertension.

机构信息

Department of hepatobiliary surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

出版信息

Cancer Med. 2021 Aug;10(16):5448-5455. doi: 10.1002/cam4.4093. Epub 2021 Jun 30.

DOI:10.1002/cam4.4093

PMID:34190423

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8366088/

Abstract

BACKGROUND

Left-sided portal hypertension is usually found in patients undergoing pancreaticoduodenectomy (PD) with spleno-mesenterico-portal (S-M-P) confluence resection. This study is to explore the outcomes of S-M-P confluence reconstruction after resection by using bifurcated allogeneic vein.

METHODS

Clinicopathologic data of patients who underwent extensive PD with S-M-P confluence resection for carcinoma of pancreatic head/uncinate process in our hospital between December 2011 and August 2018 were retrospectively reviewed and clinical outcomes of vein reconstruction after resection were analyzed.

RESULTS

Of the 37 patients enrolled, S-M-P reconstruction by bifurcated allogeneic vein was performed in 24 cases (group 1) and simply splenic vein ligation in 13 cases (group 2). Items including pathological results, blood loss, and complications were comparable between the two groups, operation time was longer in group 1 (573.8 vs. 479.2 min, p = 0.018). Significantly decreased platelet count (205.9 vs. 133.1 × 10 /L, p = 0.001) and increased splenic volume (270.9 vs. 452.2 ml, p < 0.001) were observed in group 2 at 6 months after operation. The mean splenic hypertrophy ratio was 1.06 in group 1 and 1.63 in group 2, respectively (p < 0.001). There were four patients with varices were found in group 2, none in group 1.

CONCLUSIONS

Without increased complications, reconstructing S-M-P confluence by bifurcated allogeneic vein after resection may help to avoid left-sided portal hypertension.

摘要

背景

左门脉高压症通常见于行胰十二指肠切除术（PD）伴脾肠系膜门静脉（S-M-P）汇合切除的患者。本研究旨在探讨使用分叉同种异体静脉进行 S-M-P 汇合重建后的结果。

方法

回顾性分析 2011 年 12 月至 2018 年 8 月我院因胰头/钩突部癌行广泛 PD 伴 S-M-P 汇合切除的患者的临床病理资料，分析切除术后静脉重建的临床结果。

结果

37 例患者中，24 例行分叉同种异体静脉 S-M-P 重建（组 1），13 例行单纯脾静脉结扎（组 2）。两组患者的病理结果、出血量和并发症等项目无差异，组 1 的手术时间较长（573.8 分钟比 479.2 分钟，p=0.018）。术后 6 个月，组 2 的血小板计数明显下降（205.9×10 /L 比 133.1×10 /L，p=0.001），脾脏体积明显增大（270.9 ml 比 452.2 ml，p<0.001）。组 1 的平均脾肿大率为 1.06，组 2 的平均脾肿大率为 1.63（p<0.001）。组 2 有 4 例患者发现静脉曲张，组 1 无静脉曲张。