联合肠系膜上/门静脉汇合部胰十二指肠切除术后左侧门静脉高压症的研究现状

邹洪; 朱桥; 文艺; 梁鸿寅; 周明梅; 石珂辉; 吴俊; 汤礼军

doi:10.3969/j.issn.1001-5256.2023.06.035

联合肠系膜上/门静脉汇合部胰十二指肠切除术后左侧门静脉高压症的研究现状

DOI: 10.3969/j.issn.1001-5256.2023.06.035

邹洪^a,
朱桥^b,
文艺^a,
梁鸿寅^a,
周明梅^a,
石珂辉^c,
吴俊^a,
汤礼军^a, , ,

a.
中国人民解放军西部战区总医院普通外科，成都 610083
b.
中国人民解放军西部战区总医院妇产科，成都 610083
c.
中国人民解放军西部战区总医院创伤中心，成都 610083

基金项目:

国家临床重点专科军队建设项目 (41732113);

四川省科技厅计划项目 (2019YJ0277)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：邹洪、文艺、梁鸿寅、吴俊负责课题设计，资料分析，撰写论文；朱桥、周明梅参与收集数据，修改论文；石珂辉负责文章图片的绘制；汤礼军负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
汤礼军，360914763@qq.com (ORCID: 0000-0001-6000-9515)

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出版历程
- 收稿日期: 2022-10-05
- 录用日期: 2022-11-26
- 出版日期: 2023-06-20

Current research status of left-sided portal hypertension after superior mesenteric-portal vein confluence pancreaticoduodenectomy

a.
Department of General Surgery, The General Hospital of Western Theater Command, Chengdu 610083, China
b.
Department of Obstetrics and Gynecology, The General Hospital of Western Theater Command, Chengdu 610083, China
c.
Trauma Center, The General Hospital of Western Theater Command, Chengdu 610083, China

Research funding:

National Clinical Key Specialty Military Construction Project (41732113);

Sichuan Provincial Science and Technology Department Planning Project (2019YJ0277)

More Information

Corresponding author: TANG Lijun, 360914763@qq.com (ORCID: 0000-0001-6000-9515)

摘要

摘要: 外科手术是胰腺癌最主要的治疗手段，临床上胰腺癌进行根治性外科手术时，往往需要联合肠系膜上/门静脉汇合部胰十二指肠切除术以期达到R0切除。然而，进行脾静脉离断术后可能会并发严重的左侧门静脉高压症(LSPH)，进而产生一系列病理性改变，如脾脏淤血性肿大、血小板降低、脾静脉流域回流受阻并发胃肠道静脉曲张，更有甚者会出现致命性消化道大出血、失血性休克。因此，为了临床上更好地处理LSPH，本文旨在对联合肠系膜上/门静脉汇合部胰十二指肠切除术后LSPH发生机制、治疗方案以及防治策略进行系统性分析回顾，并基于当前的研究提出相应建议。
- 胰腺肿瘤 /
- 胰十二指肠切除术 /
- 高血压 /
- 门静脉
Abstract: Surgical operation is the main treatment method for pancreatic cancer, and in clinical practice, radical surgery for pancreatic cancer is often combined with superior mesenteric-portal vein confluence pancreaticoduodenectomy to achieve R0 resection. However, severe left-sided portal hypertension (LSPH) may occur after splenic vein dissection, resulting in a series of pathological changes such as congestive splenomegaly, thrombocytopenia, backflow obstruction of splenic vein, and gastrointestinal varices, and in some cases, it can lead to fatal gastrointestinal hemorrhage and hemorrhagic shock. Therefore, in order to better manage LSPH in clinical practice, this article systematically analyzes and reviews the pathogenesis, treatment regimens, and control strategies of LSPH after combined superior mesenteric-portal vein confluence pancreaticoduodenectomy and put forward corresponding suggestions based on current studies.
- Pancreatic Neoplasms /
- Pancreaticoduodenectomy /
- Hypertension /
- Portal

HTML全文

图 1 联合门静脉-肠系膜上静脉汇合部切除术后脾脏静脉回流各种侧支循环

注：C-1，横结肠左侧Barkow弧与结肠边缘静脉的连接; C-2，横结肠右侧Barkow弧与结肠边缘静脉的连接。IMV，肠系膜下静脉; LEGV，胃左静脉; MCV，结肠中静脉; PEV，网膜后静脉; SV，脾静脉; SRCV，右上结肠静脉。绿色箭头表示关键回路: A-1、LGV、A-2、MCV、A-3和SRCV拱廊；红色箭头表示从SV到PEV和结肠边缘静脉的路径；粉色箭头表示从SV到LGEV的路线和巴科弧；蓝色箭头表示从SV到IMV和结肠边缘静脉的路径。

Figure 1. Splenic venous return to various collateral circulation after combined portal veno-superior mesenteric vein confluence resection

下载: 全尺寸图片幻灯片

图 2 PD中SMV或SV重建前后示意图

注：IJV，颈内静脉; IVC，下腔静脉; LRV，左肾静脉; PV，门静脉; SMV，肠系膜上静脉; SA，脾动脉。红线表示PV、SMV和SV的切线。a, 在肠系膜上静脉汇合门静脉区域MV进行广泛切除, 以IJV为移植物；b, 对SMV进行楔形切除，并以横向方式直接缝合重建SMV; c, PV、SMV、SV尽量靠近标本切除，SV-PV吻合(上侧)、SV-LRV吻合(下侧); d, PV、SMV、SV尽量靠近标本切除，SV-PV吻合(上侧)并联合脾动脉结扎。

Figure 2. Before and after reconstruction of superior mesenteric vein (SMV) or splenic vein (SV) in pancreaticoduodenectomy (PD)

下载: 全尺寸图片幻灯片

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