不进行动脉重建的情况下，切除腹腔干、右或左肝动脉的远端胰腺切除术（扩大的远端胰腺切除术 - 腹腔干切除）

Distal pancreatectomy with resection of the celiac trunk, right or left hepatic artery without arterial reconstruction (extended DP-CAR).

作者信息

Egorov V I, Petrov R V, Amosova E L, Kharazov A F, Petrov K S, Zhurina Yu A, Kondratyev E V, Zelter P M, Dzigasov S O, Grigorievsky M V

机构信息

Ilyinskaya Hospital, Krasnogorsk, Russia.

Vishnevsky National Medical Research Center of Surgery, Moscow, Russia.

出版信息

Khirurgiia (Mosk). 2021(10):13-28. doi: 10.17116/hirurgia202110113.

DOI:10.17116/hirurgia202110113

PMID:34608776

Abstract

OBJECTIVE

To evaluate safety and postoperative outcomes of DP-CAR with resection of one of the lobar hepatic arteries without arterial reconstruction (extended DP-CAR).

MATERIAL AND METHODS

Perioperative data and survival after 7 extended DP-CARs R0 were retrospectively analyzed. Arterial blood flow in the liver was assessed using intraoperative ultrasound and postoperative CT angiography.

RESULTS

Among 40 DP-CARs, resection of left or right hepatic artery was performed in 7 cases of aberrant anatomy including 1 case of portal vein resection. Mortality and ischemic complications were not observed. The main source of blood supply to the «devascularized» liver lobe was interlobar communicating artery or the arcade of the lesser curvature of the stomach. Incidence of pancreatic fistula was 44%, mean blood loss - 230 (100-650) ml, surgery time - 259 (195-310) min, mean hospital-stay - 14 (9-26) days. Median survival of patients with pancreatic ductal adenocarcinoma was 25 months after combined treatment. Three patients died after 26, 28 and 77 months. Other patients are alive without progression for 109, 24, 23 and 12 months after therapy onset.

CONCLUSION

Extended DP-CAR is advisable and safe procedure if reliable intraoperative control of liver and stomach blood supply is ensured.

摘要

目的

评估在不进行动脉重建的情况下切除一叶肝动脉的胰十二指肠切除术联合扩大根治术（extended DP-CAR）的安全性和术后结果。

材料与方法

回顾性分析7例R0切除的扩大根治性胰十二指肠切除术联合扩大根治术（extended DP-CAR）的围手术期数据和生存率。术中使用超声和术后CT血管造影评估肝脏的动脉血流。

结果

在40例胰十二指肠切除术联合扩大根治术（DP-CAR）中，7例解剖变异患者进行了左或右肝动脉切除，其中1例进行了门静脉切除。未观察到死亡和缺血性并发症。“去血管化”肝叶的主要血供来源是肝叶间交通动脉或胃小弯弓状动脉。胰瘘发生率为44%，平均失血量为230（100 - 650）ml，手术时间为259（195 - 310）分钟，平均住院时间为14（9 - 26）天。胰腺导管腺癌患者联合治疗后的中位生存期为25个月。3例患者分别在26、28和77个月后死亡。其他患者在治疗开始后109、24、23和12个月仍存活且无疾病进展。