Alarabiyat Moath, Chatzizacharias Nikolaos
Department of HPB and Liver Transplant Surgery, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK.
Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
Curr Oncol. 2025 May 30;32(6):316. doi: 10.3390/curroncol32060316.
Pancreatic cancer involving the porto-mesenteric junction (PMJ) represents a challenge to pancreatic surgeons. Restoring mesenteric venous drainage is an essential component of vascular reconstruction after tumour resection. In contrast, management of the splenic venous drainage can involve the ligation or reconstruction of the splenic vein (SV). Evidence suggests that splenic vein ligation (SVL) is commonly associated with sinistral portal hypertension (SPH), especially if multiple venous tributaries were divided to facilitate resection. Although the association between SVL and SPH is well documented, the risk of symptomatic SPH is not widely reported, presumably due to the low incidence and poor survival of pancreatic cancer patients. Splenic vein reconstruction (SVR) has been proposed to decrease the risk of SPH but is fraught with technical complexity and increased morbidity. Moreover, SVR does not guarantee the prevention of SPH, as patency rates vary and associated hemodynamic changes are unpredictable. Patient selection and the surgical expertise available can guide SV intraoperative management, taking into consideration the risks and benefits associated with each approach. A comprehensive review of the current literature highlighting the incidence and clinical impact of SPH after the resection of pancreatic cancer involving the PMJ is presented.
累及门静脉肠系膜交界处（PMJ）的胰腺癌对胰腺外科医生来说是一项挑战。恢复肠系膜静脉引流是肿瘤切除术后血管重建的重要组成部分。相比之下，脾静脉引流的处理可能涉及脾静脉（SV）的结扎或重建。有证据表明，脾静脉结扎（SVL）通常与左侧门静脉高压（SPH）相关，特别是如果为便于切除而切断多条静脉分支时。尽管SVL与SPH之间的关联已有充分记录，但有症状的SPH的风险尚未得到广泛报道，这可能是由于胰腺癌患者的发病率低且生存率低。有人提出脾静脉重建（SVR）以降低SPH的风险，但该方法技术复杂且发病率增加。此外，SVR并不能保证预防SPH，因为通畅率各不相同，且相关的血流动力学变化不可预测。在考虑每种方法的风险和益处时，患者选择和现有的手术专业知识可以指导SV的术中管理。本文对当前文献进行了全面综述，重点介绍了累及PMJ的胰腺癌切除术后SPH的发生率及临床影响。
