Chirurgia (Bucur). 2022 Jun;117(4):493-498. doi: 10.21614/chirurgia.2757.
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive form of pancreatic malignancy which occurs in over 90% of such cases. Pancreaticoduodenectomy (PD) is used with a curative purpose for localized PDAC. Case presentation: A 68-year-old woman presented to our service through a transfer from another service, to be investigated and treated for a head of the pancreas tumor in a tertiary referral hospital. After a complete clinical and paraclinical evaluation, the patient was diagnosed with a PDAC and also with a median arcuate ligament syndrome (MALS). The surgical treatment was considered adequate, therefore, the patient underwent a PD with transmesocolic hepaticojejunostomy, pancreaticogastric anastomosis, precolic end-to-side gastrojejunostomy, Witzel jejunostomy and with the help of the cardiovascular surgery team from the Heart Institute, Cluj- Napoca, an aortohepatic bypass using saphenous vein graft was performed. Conclusion: Bypass was essential because the blood flow in the proper hepatic artery was not restored after sectioning the median arcuate ligament and clamping the gastroduodenal artery. The patient had a favorable outcome. The particularity of the present case consists of the complete occlusion of the celiac trunk by MALS and the total vascularization of the supramesocolic organs due to the superior mesenteric artery through the gastroduodenal artery.
胰腺导管腺癌 (PDAC) 是一种侵袭性胰腺恶性肿瘤，占此类病例的 90%以上。胰十二指肠切除术 (PD) 用于治疗局部 PDAC。病例报告：一位 68 岁女性因胰头肿瘤在一家三级转诊医院被转至我们科室接受检查和治疗。经过全面的临床和辅助检查评估，患者被诊断为 PDAC，同时还患有中弓状韧带综合征 (MALS)。手术治疗被认为是充分的，因此，患者接受了 PD 手术，包括经肠系膜肝肠吻合术、胰胃吻合术、结肠前侧侧胃空肠吻合术、Witzel 空肠造口术，并在克卢日-纳波卡心脏研究所的心血管外科团队的帮助下，使用隐静脉移植物进行了肝动脉旁路手术。结论：旁路手术是必要的，因为在切断中弓状韧带并夹闭胃十二指肠动脉后，肝固有动脉的血流没有恢复。患者预后良好。本病例的特殊性在于 MALS 导致腹腔干完全闭塞，以及通过胃十二指肠动脉来自肠系膜上动脉的超肠系膜上器官的完全血管化。
