Arterial resection and reconstruction in pancreatectomy: surgical technique and outcomes
Arterial resection and reconstruction in pancreatectomy: surgical technique and outcomes
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胰腺切除术中的动脉切除和重建：手术技术和结果
DOI：
10.1186/s12893-019-0560-2
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发表时间：
2019-10-10
期刊：
影响因子：
1.9
通讯作者：
Wang, Weilin
中科院分区：
文献类型：
--
作者：
Zhang, Qiyi;Wu, Jingjin;Wang, Weilin
背景胰腺或壶腹肿瘤患者的预后仍然不令人满意，特别是侵犯肝动脉（HA）或肠系膜上动脉（SMA）的患者。在这种情况下，胰腺切除术联合动脉切除术和重建可能提供全块切除的可能性，阴性边缘和可接受的发病率和死亡率。方法回顾性分析我院6年的胰腺切除术，包括21例胰切除术联合动脉切除和重建的患者。在手术显微镜下进行动脉重建。动脉重建的类型包括直接吻合、动脉转位和动脉搭桥血管移植。结果本组共行胰十二指肠切除术19例，全胰切除术2例。肿瘤位于胰头（n= 10）、全胰（n= 2）、胆总管远端（n= 5）、壶腹（n= 2）和腹膜后并累及胰头（n= 2）。所有手术均成功切除R0，无术中并发症。18例患者无并发症康复，3例患者死于胰瘘引起的腹内出血，但值得注意的是出血不在动脉吻合处。所有重建动脉在随访时显示足够的通畅。11例胰腺腺癌患者的中位术后生存期均为11.6个月。结论胰切除术联合动脉切除重建是一种可行的治疗方法。显微外科技术是实现动脉吻合成功和通畅的关键。
BackgroundThe outcomes in patients with pancreatic or ampulla tumors remain unsatisfactory, especially with invasion into the hepatic artery (HA) or the superior mesenteric artery (SMA). In this setting, pancreatectomy combined with arterial resection and reconstruction may offer the possibility of an en-block resection with negative margins and acceptable morbidity and mortality.MethodsA six year retrospective review of pancreatectomies performed at our institution, included 21 patients that underwent a pancreatectomy combined with arterial resection and reconstruction. Arterial reconstruction was performed under an operating microscope. The types of arterial reconstruction included direct anastomosis, arterial transposition, and arterial bypass with a vascular graft.ResultsThe surgical procedures consisted of 19 pancreaticoduodenectomies and 2 total pancreatectomies. The tumors were located at the pancreatic head (n= 10), whole pancreas (n= 2), distal common bile duct (n= 5), ampulla (n= 2) and retroperitoneum with pancreatic head involvement (n= 2). All operations achieved R0 resection successfully, with no intraoperative complication. Eighteen patients recovered without complications while three patients died from intra-abdominal hemorrhage due to a pancreatic fistula, though notably the bleeding was not at the arterial anastomosis site. All reconstructed arteries showed adequate patency at follow-up. The median postoperative survival was 11.6 months in all the 11 patients with pancreatic adenocarcinoma.ConclusionPancreatectomy combined with arterial resection and reconstruction is a feasible treatment option. The microsurgical technique is critically important to achieving a successful and patent arterial anastomosis.