Wang Jing, Lyu Shao-Cheng, Cui Song-Ping, Huang Jin-Can, Wang Han-Xuan, Hu Bin, He Qiang, Lang Ren
Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Mass General Cancer Cennter, Mass General Brigham, Harvard Medical School.
Int J Surg. 2025 Jan 1;111(1):9-19. doi: 10.1097/JS9.0000000000001944.
Sinistral portal hypertension (SPH) may occur in patients with pancreatic carcinoma after pancreaticoduodenectomy (PD) with spleno-mesenterico-portal (S-M-P) confluence resection. This study aimed to evaluate outcomes with bifurcated allogeneic vein replacement in the prevention of SPH in pancreatic carcinoma patients.
A total of 81 patients were included. The authors retrospectively collected clinicopathological data from 66 patients underwent PD with S-M-P confluence resection in our hospital from January 2011 to December 2021, compared the correlation between different venous reconstruction methods using log-rank tests and clinical outcomes through univariate and multivariate analyses. Secondly, the authors prospectively collected clinical data and outcomes of 15 patients who underwent splenic vein reconstruction from January 2021 to January 2023.
In the retrospective study, 43 cases received reconstruction by bifurcated allogeneic vein (Reconstruction group) and 23 cases received simply SV ligation (Ligation group). The preoperative platelet counts and spleen volume were similar between two groups ( P >0.05). Nevertheless, at 1 month, 3 months and 6 months after operation, the related indexes of SPH such as platelet count, spleen volume, spleen volume ratio and esophagogastric varices (EGV) grade in Reconstruction group were better than those in Ligation group ( P <0.05). 6 months after surgery, the incidence of SPH in Ligation group was significantly higher than in Reconstruction group (36.4% vs. 8.1%, respectively). In the prospective study, the incidence of SPH in patients undergoing SV reconstruction was 6.7% (1/15).
Without compromising surgical outcomes, reconstruction of the S-M-P confluence by bifurcated allogeneic vein is a better method to avoid SPH in patients with advanced pancreatic carcinoma.
在胰十二指肠切除术（PD）并脾-肠系膜-门静脉（S-M-P）汇合处切除术后，胰腺癌患者可能发生左侧门静脉高压（SPH）。本研究旨在评估分叉异体静脉置换术预防胰腺癌患者SPH的效果。
共纳入81例患者。作者回顾性收集了2011年1月至2021年12月在我院接受PD并S-M-P汇合处切除的66例患者的临床病理数据，采用对数秩检验比较不同静脉重建方法之间的相关性，并通过单因素和多因素分析比较临床结局。其次，作者前瞻性收集了2021年1月至2023年1月接受脾静脉重建的15例患者的临床数据和结局。
在回顾性研究中，43例接受分叉异体静脉重建（重建组），23例接受单纯脾静脉结扎（结扎组）。两组术前血小板计数和脾脏体积相似（P>0.05）。然而，术后1个月、3个月和6个月，重建组SPH的相关指标如血小板计数、脾脏体积、脾脏体积比和食管胃静脉曲张（EGV）分级均优于结扎组（P<0.05）。术后6个月，结扎组SPH的发生率显著高于重建组（分别为36.4%和8.1%）。在前瞻性研究中，接受脾静脉重建的患者中SPH的发生率为6.7%（1/15）。
在不影响手术效果的情况下，分叉异体静脉重建S-M-P汇合处是避免晚期胰腺癌患者发生SPH的较好方法。
