分支异体血管置换对胰腺癌术后患者左侧区域性门静脉高压的预防作用

摘要

目的 探讨分支异体血管置换技术预防胰腺癌术后患者左侧区域性门静脉高压的效果.方法 收集2011年1月至2017年12月在首都医科大学附属北京朝阳医院接受治疗的胰腺肿瘤累及门静脉、肠系膜上静脉、脾静脉汇合部的胰头癌患者25例.患者均行联合受侵静脉切除、分支异体血管重建的根治性胰十二指肠切除术,观察患者术后胃镜检查有无食管胃底静脉曲张,手术前后白细胞、血小板、脾脏体积的变化,继而明确手术后出现左侧区域性门静脉高压的发生率.结果 25例患者随访期间门静脉、肠系膜上静脉、脾静脉吻合口通畅,无吻合口血栓形成;术后胃镜检查无新发食管胃底静脉曲张,手术前后白细胞、血小板、脾脏体积变化差异均无统计学意义(均P＞0.05),即25例患者术后均无左侧区域性门静脉高压表现.患者术后均获得随访,生存期(20.2±3.7)个月,1年生存率44.0％.结论 分支异体血管置换技术能有效预防胰腺癌术后左侧区域性门静脉高压的发生.%Objective To study the impact on the use of branched vascular allografts in the prevention of left regional portal hypertension after pancreatic cancer operations.Methods This retrospective study included 25 patients who underwent pancreaticoduodenectomy for pancreatic head cancer which involved the portal vein,superior mesenteric vein and splenic venous confluence between January 2011 to December 2017 in the Beijing Chao Yang Hospital,Capital Medical University.These patients underwent "en bloc" resection of the spleno-mesenterio-portal (SMS) venous axis with replacement of a branched vascular allografts.They were studied to see whether gastroesophageal varices were found on gastroscopy and whether there were any changes in leukocyte,platelet and splenic volume before and after the operation to determine the incidence of left regional portal hypertension after operation.Results During the follow-up period,all the portal vein,superior mesenteric vein and splenic vein anastomoses were unobstructed and without any thrombosis.No new varices were found on gastroscopy.There were no significant differences in the white blood cell count,platelets count and splenic volume before and after the operations (all P＞0.05).The 25 patients had no left regional portal hypertension.Survival time and one year survival rate of the patients were (20.2±3.7) months and 44.0％.Conclusion Branched vascular allografts effectively prevented the occurrence of left regional portal hypertension after radical pancreaticoduodenectomy with resection of SMP.