Gyoten Kazuyuki, Mizuno Shugo, Nagata Motonori, Ito Takahiro, Hayasaki Aoi, Murata Yasuhiro, Tanemura Akihiro, Kuriyama Naohisa, Kishiwada Masashi, Sakurai Hiroyuki
Department of Hepatobiliary Pancreatic and Transplant Surgery Mie University School of Medicine Tsu Japan.
Department of Radiology Mie University School of Medicine Mie University School of Medicine Tsu Japan.
Ann Gastroenterol Surg. 2022 Feb 10;6(3):420-429. doi: 10.1002/ags3.12545. eCollection 2022 May.
Left-sided portal hypertension (LSPH) caused by splenic vein (SV) division in pancreaticoduodenectomy (PD) with portal vein (PV) resection remains challenging. The current study aimed to investigate the efficacy of splenic artery (SA) ligation in preventing LSPH.
One-hundred thirty patients who underwent PD with PV resection for pancreatic ductal adenocarcinoma were classified into SV and SA preservation (SVP, n = 30), SV resection and SA preservation (SVR, n = 59), and SV resection and SA ligation (SAL, n = 41). The postoperative incidence of LSPH was assessed.
The incidence of variceal formation in SVP, SVR, and SAL were 4.8%, 53.2%, and 46.4% at 3 mo, 13.0%, 71.2%, and 62.5% at 6 mo, and 25.0%, 87.5%, and 87.1% at 12 mo, respectively. The rate was significantly higher in SVR at 3 and 6 mo ( = .001 and < .001, respectively) and in SVR and SAL ( < .001) at 12 mo. Variceal hemorrhage occurred only in SVR (n = 4). The platelet count ratio at 3, 6, and 12 mo began to significantly decrease from 3 mo in SVR (0.77, 0.67, and 0.60, respectively; < .001) and 6 mo in SAL (0.91, 0.73, and 0.69, respectively; < .001). The spleen volume ratio also showed significant increase from 3 mo in SVR (1.24, 1.34, and 1.42, respectively; < .001) and 6 mo in SAL (1.31, 1.32, and 1.34, respectively; < .001). SVR and SAL were significant risk factors for variceal formation at 12 mo (odds ratio, 21.0 and 20.3, respectively).
In PD with PV resection, SAL delayed LSPH but could not prevent its occurrence.
在门静脉（PV）切除的胰十二指肠切除术（PD）中，脾静脉（SV）离断导致的左侧门静脉高压（LSPH）仍然是一个具有挑战性的问题。本研究旨在探讨脾动脉（SA）结扎在预防LSPH中的疗效。
130例行PV切除的胰腺导管腺癌患者被分为保留SV和SA组（SVP，n = 30）、切除SV并保留SA组（SVR，n = 59）以及切除SV并结扎SA组（SAL，n = 41）。评估术后LSPH的发生率。
SVP、SVR和SAL组3个月时静脉曲张形成的发生率分别为4.8%、53.2%和46.4%，6个月时分别为13.0%、71.2%和62.5%，12个月时分别为25.0%、87.5%和87.1%。SVR组在3个月和6个月时的发生率显著更高（分别为P = 0.001和P < 0.001），在12个月时SVR组和SAL组也显著更高（P < 0.001）。静脉曲张出血仅发生在SVR组（n = 4）。SVR组3个月、6个月和12个月时的血小板计数比值从3个月开始显著下降（分别为0.77、0.67和0.60；P < 0.001），SAL组6个月时开始显著下降（分别为0.91、0.73和0.69；P < 0.001）。脾体积比值在SVR组从3个月开始也显著增加（分别为1.24、1.34和1.42；P < 0.001），在SAL组6个月时开始显著增加（分别为1.31、1.32和1.34；P < 0.001）。SVR和SAL是1
