中国普外基础与临床杂志

中国普外基础与临床杂志

胰头癌并门静脉和肠系膜上静脉/脾静脉汇合部同时受侵的血管重建方法

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目的 总结胰头癌并门静脉(PV)和肠系膜上静脉(SMV)/脾静脉(SV)汇合部同时受侵的胰十二指肠切除术(PD)联合 PV 和 SMV/SV 汇合部切除并血管重建这一特殊方法的临床疗效。 方法 上海交通大学附属第一人民医院于 2017 年 3 月收治了 1 例胰头癌并 PV 和 SMV/SV 汇合部同时受侵的患者,根据术前 CT 检查所示的肿瘤与血管浸润程度判断为 Loyer E 型。SMV/SV 汇合部受侵部分位于 SV/SMV 汇合部的右侧壁,浸润深度向下未超过 SV/SMV 汇合部最低点。行 PD 联合受侵的 PV 和 SMV/SV 汇合部右侧部分切除(SMV/SV 汇合部右侧部分弧形切除),保留 SMV/SV 汇合部左侧部分,然后使用人造血管行 PV 和 SMV/SV 汇合部残端吻合。 结果 患者的手术时间共计 380 min,出血量约 200 mL,PV、SMV 及 SV 的阻断时间分别为 35、30 及 30 min,术后无胰瘘、胆汁漏、切口感染、肺部感染、人造血管感染、血栓、肝功能衰竭等并发症发生。患者于术后第 12 天痊愈出院。术后 1 个月复查上腹部 CT 血管造影(CTA)见人造血管通畅良好;术后 3、6、9 及 12 个月电话随访未诉明显不适;术后 12 个月复查胸、腹部 CT 检查未发现肿瘤复发及转移,复查肝功能正常。 结论 对胰头癌并 PV 和 SMV/SV 汇合部同时受侵者,行 PD 联合 PV 和 SMV/SV 汇合部右侧部分切除,保留 SMV/SV 汇合部左侧部分,再对 PV 断端行人造血管重建是一种特殊的吻合方法,减少了 SV 单独重建吻合口,从而缩短了 PV 阻断时间,缩短肝脏缺血时间,对患者术后肝功能的快速恢复起到了重要的作用。

Objectives To summary the clinical effect of special method of vascular reconstruction in pancreaticoduodenectomy (PD) combined with portal vein (PV) and superior mesenteric vein (SMV)/spleen vein(SV) confluence resection in the treatment of pancreatic head cancer with PV, SMV/SV confluence were both invaded by tumor. Methods Retrospectively summarized the clinical data of 1 pancreatic head cancer patient who got treatment at Shanghai General Hospital in March 2017, whose PV and SMV/SV confluence were both invaded by tumor, According to the preoperative CT judgment, the degree of tumor and vascular infiltration was determined as type of Loyer E, the invasion part was located on the right wall of the SMV/SV confluence, and the depth of infiltration did not exceed the lowest point of the SMV/SV confluence junction. This patient underwent PD combined with the invasion of the PV and the right part of SMV/SV confluence resection, wiht the left part of SMV/SV confluence was retained, and then vascular graft was used for the anastomosis between the PV and the SMV/SV confluence. Results The patient’s operation time was 380 min, and the blood loss was 200 mL. The blocking time of PV, SMV, and SV were 35, 30, and 30 min, respectively, without postoperative pancreatic fistula, biliary leakage, incision infection, pulmonary infection, vascular graft infection, blood clots, liver failure, and other complications. The patient recovered and discharged from hospital in postoperative twelfth day. In postoperative 1-month, the patient reviewed on abdomen CT angiography (CTA), showing the vascular graft unobstructed. . In postoperative 3-, 6-, 9-, and 12- months, there were no obvious discomfort, and review on chest and abdominal CT found no tumor recurrence and metastasis in postoperative 12-months, as well as liver function was normal. Conclusions For pancreatic head cancer with PV and SMV/SV confluence were both invaded by tumor, PD combined with the invasion of the PV and the right part of SMV/SV confluence resection, then the left part of SMV/SV confluence and PV was anastomosed by vascular graft, this is a special method of vascular reconstruction. It can reduce SV to reconstruct the anastomosis separately, shorten PV blocking time and the liver ischemia time, it was very important in the rapid recovery of the liver function.

关键词: 胰头癌; 胰十二指肠切除术; 人造血管重建术; 门静脉; 肠系膜上静脉

Key words: pancreatic head cancer; pancreaticoduodenectomy; vascular graft reconstruction; portal vein; superior mesenteric vein

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