Cillo Umberto, Perri Giampaolo, Gringeri Enrico, Bassi Domenico, Marchegiani Giovanni
Hepato-Pancreato-Biliary and Liver Transplant Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy.
Ann Surg Oncol. 2025 Sep 4. doi: 10.1245/s10434-025-18148-1.
Different techniques for venous resection and reconstruction during pancreatoduodenectomy are available, each with different advantages and drawbacks.
In this multimedia article, a detailed description of the surgical technique of venous resection with peritoneal (falciform) patch reconstruction is provided, including examples of extended (> 5 cm) or low (jejunal veins confluence) venous infiltrations, during both open and robotic pancreatoduodenectomy.
Reconstruction with patch is a versatile technique, typically fit for lateral but cranio-caudally prolonged tumor involvements, which unlike segmental resection allows preservation of venous collaterals, where a simple tangential resection would jeopardize oncologic radicality or increase the risk of stenosis. Moreover, maintaining the original venous axis and direction, it avoids the risk of torsion or kinking potentially associated with segmental resection with or without interposition graft.
The patch reconstruction combines the advantages of both tangential and segmental resection. It can be used for low or extended infiltrations, during open or robotic surgery, preserving venous collaterals without sacrificing radicality, and using prophylactic anticoagulation only.
胰十二指肠切除术中静脉切除与重建有不同技术，各有优缺点。
在这篇多媒体文章中，详细描述了采用腹膜（镰状）补片重建进行静脉切除的手术技术，包括开放和机器人胰十二指肠切除术中广泛（>5厘米）或低位（空肠静脉汇合处）静脉浸润的实例。
补片重建是一种通用技术，通常适用于侧向但头-尾向延长的肿瘤累及情况，与节段性切除不同，它能保留静脉侧支，而单纯的切线切除会危及肿瘤根治性或增加狭窄风险。此外，保持原静脉轴和方向，可避免与带或不带间置移植物的节段性切除相关的扭转或扭结风险。
补片重建结合了切线切除和节段性切除的优点。它可用于开放或机器人手术中的低位或广泛浸润，保留静脉侧支而不牺牲根治性，且仅使用预防性抗凝。
