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胰十二指肠切除联合门静脉重建术后急性肠系膜上静脉狭窄的经皮经肝支架置入术:病例报告

Percutaneous transhepatic stenting for acute superior mesenteric vein stenosis after pancreaticoduodenectomy with portal vein reconstruction: A case report.

作者信息

Lin Chen, Wang Zi-Yan, Dong Liang-Bo, Wang Zhi-Wei, Li Ze-Hui, Wang Wei-Bin

机构信息

Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.

Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China.

出版信息

World J Gastrointest Surg. 2024 Apr 27;16(4):1195-1202. doi: 10.4240/wjgs.v16.i4.1195.

Abstract

BACKGROUND

Percutaneous transhepatic stent placement has become a common strategy for the postoperative treatment of portal vein (PV)/superior mesenteric veins (SMV) stenosis/occlusion. It has been widely used after liver transplantation surgery; however, reports on stent placement for acute PV/SMV stenosis after pancreatic surgery within postoperative 3 d are rare.

CASE SUMMARY

Herein, we reported a case of intestinal edema and SMV stenosis 2 d after pancreatic surgery. The patient was successfully treated using stent grafts. Although the stenosis resolved after stent placement, complications, including bleeding, pancreatic fistula, bile leakage, and infection, made the treatment highly challenging. The use of anticoagulants was adjusted multiple times to prevent venous thromboembolism and the risk of bleeding. After careful treatment, the patient stabilized, and stent placement effectively managed postoperative PV/SMV stenosis.

CONCLUSION

Stent placement is effective and feasible for treating acute PV/SMV stenosis after pancreatic surgery even within postoperative 3 d.

摘要

背景

经皮肝穿刺支架置入术已成为门静脉(PV)/肠系膜上静脉(SMV)狭窄/闭塞术后治疗的常用策略。该技术在肝移植手术后已被广泛应用;然而,关于胰腺手术后3天内急性PV/SMV狭窄支架置入的报道却很少。

病例总结

在此,我们报告1例胰腺手术后2天出现肠水肿和SMV狭窄的病例。该患者采用覆膜支架成功治疗。尽管支架置入后狭窄得以缓解,但包括出血、胰瘘、胆漏和感染在内的并发症使治疗极具挑战性。多次调整抗凝药物的使用以预防静脉血栓栓塞和出血风险。经过精心治疗,患者病情稳定,支架置入有效处理了术后PV/SMV狭窄。

结论

即使在胰腺手术后3天内,支架置入对于治疗急性PV/SMV狭窄也是有效且可行的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7d1/11056671/b0bc0d8f4295/WJGS-16-1195-g001.jpg

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