Tamura K, Sumi S, Koike M, Yano S, Nagami H, Nio Y
First Department of Surgery, Shimane Medical University, Izumo, Japan.
Int Surg. 1997 Apr-Jun;82(2):155-9.
In order to prevent gastric congestion after both of the splenic and coronary veins were taken as part of extensive portal vein resection in pylorus preserving (PP) pancreatoduodenectomy (PD), we made a splenic-inferior mesenteric venous (SpIMV) anastomosis.
Four patients underwent PP subtotal PD with such extensive portal vein resection under the diagnosis of pancreas head cancer. The portal vein was reconstructed by end-to-end anastomosis, and the coronary vein was ligated. Since the stump of the splenic vein could not be approximated to the portal or superior mesenteric vein, shunting the splenic venous flow to the inferior mesenteric vein was attempted by making a SpIMV anastomosis in 3 patients and by preserving the SpIMV confluence in a patient. Postoperative celiac angiography showed that venous outflow from the stomach, spleen and remnant pancreas collected into the splenic vein and passed through the SpIMV anastomosis or confluence, and finally drained into the portal vein by inferior mesenteric to superior mesenteric collateral.
No remarkable congestion of the stomach was observed.
In conclusion making a SpIMV anastomosis or preserving the SKpIMV confluence is beneficial for preventing gastric congestion following PP PD with extensive portal vein resection for cancer of the head of the pancreas.
在保留幽门的胰十二指肠切除术（PPPD）中，为防止在广泛门静脉切除时同时离断脾静脉和冠状静脉后出现胃淤血，我们进行了脾静脉-肠系膜下静脉（SpIMV）吻合术。
4例因胰头癌诊断而接受PPPD并进行广泛门静脉切除的患者。门静脉通过端端吻合重建，冠状静脉结扎。由于脾静脉残端无法与门静脉或肠系膜上静脉靠近，因此在3例患者中尝试通过进行SpIMV吻合术将脾静脉血流分流至肠系膜下静脉，并在1例患者中保留SpIMV汇合处。术后腹腔血管造影显示，胃、脾和残余胰腺的静脉血流入脾静脉，通过SpIMV吻合术或汇合处，最终经肠系膜下静脉至肠系膜上静脉侧支引流至门静脉。
未观察到明显的胃淤血。
总之，进行SpIMV吻合术或保留SpIMV汇合处有利于预防因胰头癌行广泛门静脉切除的PPPD术后的胃淤血。
