Wei Ruili, Huang Jia, Luo Yingjixing, Liu Ruyi, Qiu Yue, Xu Li, Huang Hanchun, Zhou Wenying, Sun Yongliang, Yang Zhiying
Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, No.2 Yinghua East Street, Chaoyang District, Beijing, 100029, China.
Capital Medical University China-Japan Friendship School of Clinical Medicine, Beijing, China.
Langenbecks Arch Surg. 2025 Aug 25;410(1):250. doi: 10.1007/s00423-025-03826-1.
In pancreaticoduodenectomy, extensive involvement of the superior mesenteric vein (SMV) often complicates venous reconstruction, especially when artificial grafts are unavailable. In such cases, meso-caval shunt (MCS) emerges as a solution. This study aimed to evaluate the safety and efficacy of permanent MCS as both an emergency procedure and a planned surgical strategy.
We retrospectively analyzed 8 consecutive patients undergoing pancreaticoduodenectomy with permanent MCS between July 2019 and January 2025 at our institution. Clinicopathological characteristics were identified using electronic medical records, and the same surgeon performed all surgeries.
The study included seven cases of pancreatic cancer and one ampullary carcinoma (6 male, 2 females; age 54-71 years). The mean operative duration was 510 min with 767 ml blood loss. All patients achieved R0 resection with minor complications (Clavien-Dindo grade I/II), no mortality, and preserved portal perfusion. Meso-caval shunt patency was confirmed postoperatively without hepatic dysfunction. Median survival reached 21 months.
Permanent MCS is a reliable elective option for venous reconstruction in pancreaticoduodenectomy, especially when graft-based solutions are not available. Its success in achieving R0 resection while maintaining portal hemodynamics suggests its utility in complex pancreatic resections.
在胰十二指肠切除术中，肠系膜上静脉（SMV）广泛受累常使静脉重建复杂化，尤其是在无法获得人工移植物的情况下。在这种情况下，肠系膜上腔静脉分流术（MCS）成为一种解决方案。本研究旨在评估永久性MCS作为急诊手术和计划性手术策略的安全性和有效性。
我们回顾性分析了2019年7月至2025年1月在我院接受永久性MCS胰十二指肠切除术的8例连续患者。使用电子病历确定临床病理特征，所有手术均由同一位外科医生进行。
该研究包括7例胰腺癌和1例壶腹癌（6例男性，2例女性；年龄54 - 71岁）。平均手术时间为510分钟，失血767毫升。所有患者均实现R0切除，并发症轻微（Clavien-Dindo I/II级），无死亡病例，门静脉灌注得以保留。术后证实肠系膜上腔静脉分流术通畅，无肝功能障碍。中位生存期达21个月。
永久性MCS是胰十二指肠切除术中静脉重建的可靠选择，尤其是在无法采用基于移植物的解决方案时。它在实现R0切除同时维持门静脉血流动力学方面的成功表明其在复杂胰腺切除术中的实用性。
