自体左肾静脉在胰十二指肠切除联合门静脉-肠系膜上静脉切除重建中的应用  

Use of autologous left renal vein as a graft vessel for reconstruction after portal vein-superior mesenteric vein resection in pancreaticoduodenectomy

作　　者：任为正[1] 辛宪磊[1] 刘志伟[1] 陈继业[1] 蔡守旺[1] Ren Weizheng;Xin Xianlei;Liu Zhiwei;Chen Jiye;Cai Shouwang(Faculty of Hepato-Pancreato-Biliary Surgery,Chinese PLA General Hospital,Institute of Hepatobiliary Surgery of Chinese PLA,Key Laboratory of Digital Hepetobiliary Surgery,PLA,Beijing 100853,China)

机构地区：[1]解放军总医院肝胆胰外科医学部解放军总医院肝胆外科研究所全军数字肝胆外科重点实验室,北京100853

出　　处：《中华肝胆外科杂志》2021年第5期350-353,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：北京市自然科学基金(7194317)。

摘　　要：目的分析自体左肾静脉在胰十二指肠切除联合门静脉-肠系膜上静脉(PV-SMV)切除重建中的应用效果。方法回顾性分析2008年7月至2017年12月于解放军总医院行胰十二指肠切除术的5例患者资料,均联合PV-SMV切除重建且以左肾静脉为桥血管。分析患者手术相关指标、并发症和随访情况。结果5例患者中女性1例,男性4例,年龄范围33~72岁,平均年龄57岁。手术时间5.4~9.1 h,平均6.8 h。肿瘤最大径2.8~4.8 cm,平均3.8 cm。PV-SMV缺损段长度3.2~4.6 cm,平均3.8 cm,取自体左肾静脉长度3.0~4.1 cm,平均3.4 cm。术后病理3例为胰腺癌,2例为结肠癌胰腺转移。5例患者镜下均可见PV-SMV侵犯。术后住院时间10~25 d,平均12 d。无围手术期死亡。围手术期并发症包括胃排空延迟、腹水、腹泻各1例。术前肌酐70~98μmol/L,出院时62~107μmol/L。术后肌酐一过性升高,峰值为80~156μmol/L。随访4.3~17.8个月,2例患者因复发和转移于术后14.2、17.8个月死亡。结论左肾静脉作为胰十二指肠切除术中PV-SMV重建的桥血管,管径匹配、侧支丰富,可取用长度足够,位于术野,取用方便,且切除后对肾功能影响为一过性。Objective To study the use of left renal vein as a graft vessel in reconstruction after portal vein/superior mesenteric vein(PV-SMV)resection in pancreaticoduodenectomy.Methods A retrospective study was conducted on 5 of these patients who underwent surgery from July 2008 to December 2017 at Chinese PLA General Hospital.The operative,complication and follow-up data were analysed.Results There were 4 males and 1 female,with an average age of 57(33-72)years.The mean operative time was 6.8(5.4-9.1)h and the mean tumor size was 3.8(2.8-4.8)cm.The average length of the PV-SMV defect left after resection was 3.8(3.2-4.6)cm.The average length of the left renal vein used was 3.4(3.0-4.1)cm.The operations were carried out in 3 patients with pancreatic cancer and in 2 patients with colon cancer pancreatic metastasis.The average postoperative hospital stay was 12(10-25)days.Perioperative complications included 1 patient each with ascites,diarrhea and delayed gastric emptying.The creatinine levels ranged from 70-98μmol/L preoperatively,with a transient creatinine rise to 80-156μmol/L after operation and became 62-107μmol/L upon discharge from hospital.The follow-up time was 4.3-17.8 months.Two patients died of recurrence/metastasis at 14.2 and 17.8 months after surgery.Conclusions The left renal vein has the appropriate diameter and rich collateral branches.It has a sufficient length and it is conveniently located in the surgical field.This study showed that there was a minimal effect on renal function after its excision,and it can be used as a graft vessel for reconstruction in pancreaticoduodenectomy after PV-SMV resection.

关 键 词：胰十二指肠切除术 门静脉 肠系膜上静脉 左肾静脉 桥血管 

分 类 号：R735.9[医药卫生—肿瘤]