Kang Mee Joo, Han Sung-Sik, Park Sang-Jae, Park Hyeong Min, Kim Sun-Whe
Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea.
Ann Hepatobiliary Pancreat Surg. 2022 Aug 31;26(3):229-234. doi: 10.14701/ahbps.22-013. Epub 2022 Aug 8.
When planning pancreaticoduodenectomy for pancreatic head cancer, the prevalence of anatomical variation of the proximal jejunal vein (PJV), the associated short-term surgical outcomes, and the level of PJV convergence to the superior mesenteric vein must be carefully analyzed from both technical and oncological points of view. The prevalence of the first jejunal trunk (FJT) and PJV located ventral to the superior mesenteric artery is 58%-88% and 13%-37%, respectively. Patients with the FJT had a larger amount of intraoperative bleeding and a higher proportion of patients requiring transfusions compared to those without a common trunk. The risk of transfusion was higher in patients with ventral PJV compared to those with dorsal PJV. Although less frequent, sacrificing the FJT can result in fatal venous congestion of the jejunum. Therefore, a well-planned approach for pancreaticoduodenectomy, based on preoperative evaluation of anatomical variation in the PJV, may help reduce intraoperative bleeding and postoperative morbidity. Additionally, the importance of invasion into the PJVs should be revisited in terms of resectability and oncological clearance.
在为胰头癌规划胰十二指肠切除术时，必须从技术和肿瘤学角度仔细分析空肠近端静脉（PJV）解剖变异的发生率、相关的短期手术结果以及PJV汇入肠系膜上静脉的水平。第一空肠干（FJT）和位于肠系膜上动脉腹侧的PJV的发生率分别为58%-88%和13%-37%。与没有共同干的患者相比，有FJT的患者术中出血量更大，需要输血的患者比例更高。与背侧PJV的患者相比，腹侧PJV的患者输血风险更高。虽然较少见，但牺牲FJT可能导致空肠致命性静脉淤血。因此，基于术前对PJV解剖变异的评估，精心规划的胰十二指肠切除术方法可能有助于减少术中出血和术后发病率。此外，应从可切除性和肿瘤学切缘方面重新审视侵犯PJV的重要性。
