Han Ahram, Ahn Sanghyun, Min Seung-Kee
Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Vasc Specialist Int. 2024 Dec 31;40:45. doi: 10.5758/vsi.240073.
Major vessel invasion, particularly involving the portal and superior mesenteric veins, poses significant challenges during the radical resection of hepatobiliary and pancreatic cancers. Oncovascular surgery is essential for curative outcomes, and often requires portomesenteric vein reconstruction. Techniques, such as lateral venorrhaphy, patch repair, end-to-end anastomosis, and interposition grafting, have been employed. Autogenous veins such as the internal jugular, left renal, external iliac, or femoral veins are options, although not always available. Alternatives include great saphenous vein grafts, other autogenous materials, including the parietal peritoneum, bovine patches and allografts. Despite the higher risks of infection and thrombosis, prosthetic grafts are also considered. Ensuring long-term patency through meticulous surgical techniques is crucial for preventing complications, such as thrombosis and variceal bleeding.
主要血管侵犯，尤其是累及门静脉和肠系膜上静脉，在肝胆胰癌的根治性切除术中带来了重大挑战。肿瘤血管手术对于获得治愈性结果至关重要，并且通常需要进行门静脉肠系膜静脉重建。已经采用了诸如侧方静脉缝合、补片修补、端端吻合和间置移植等技术。自体静脉，如颈内静脉、左肾静脉、髂外静脉或股静脉是可供选择的，但并非总是可用。其他选择包括大隐静脉移植物、其他自体材料，包括壁腹膜、牛心包补片和同种异体移植物。尽管感染和血栓形成的风险较高，但人工血管也在考虑范围内。通过精细的手术技术确保长期通畅对于预防诸如血栓形成和静脉曲张出血等并发症至关重要。
