切除脾血管保留脾脏的胰体尾切除术后胃脾区血流情况的改变

Hemodynamic changes of gastrosplenic region after spleen-preserving distal pancreatectomy with excision of splenic vessels

目的观察切除脾血管保留脾脏的胰体尾切除术后胃脾区血流情况的改变。方法上海交通大学医学院附属新华医院于2005年7月—2010年3月间对11例患者行切除脾血管保留脾脏的胰体尾切除术,于术后第3、12个月进行上腹部CT血管造影(CTA)成像和纤维胃镜检查,观察脾脏大小、胃食管及周围静脉情况。结果术后平均随访(37.4±17.7)个月。术后3个月时CTA检查示,脾脏肿大4例(4/11),胃周静脉曲张3例(3/11),胃黏膜下静脉曲张1例(1/11)。术后12个月时复查CTA示,4例脾脏肿大患者中,1例缓解,3例基本保持稳定,无新发脾脏肿大;3例胃周静脉曲张患者的情况稳定无进展,无新发胃周静脉曲张;1例胃黏膜下静脉曲张患者的情况稳定无明显进展。术后3个月胃镜检查示胃壁静脉曲张1例,术后12个月复查胃镜示胃壁静脉曲张无进展。结论切除脾血管保留脾脏的胰体尾切除术后脾胃区血流发生改变,但无证据证实上消化道出血是其远期并发症。

Objective To evaluate the hemodynamic change in the gastrosplenic region after spleen- preserving distal pancreatectomy with excision of splenic vessels （SpDP-ESV）. Methods From July 2005 to March 2010, 11 patients underwent SpDP-ESV. The clinical data including spleen, stomach, esophagus and peripheral veins were retrospectively analyzed by epigastric computed tomography angiography （CTA） and gastroscopy 3 and 12 months postoperatively. Results After a follow up of （37.4--- 17.7） months, out of the 11 cases, 4 （4/11 ） had splenomegaly, 3 （3/11 ） had perigastric varices, and 1 （ 1/11 ） had gastric submucosal varices on CT 3 months after surgery. CT scan performed 12 months after surgery showed that splenomegaly got relief in one patient, and the condition of other patient （3 with splenomegaly, 3 with perigastric varices, and 1 with submucosal varices） kept stable and no new case appeared. Gastroscopy showed that the gastric varices was found in one patient 3 months postoperatively and there was no further development 12 months postoperatively. Conclusion SpDP-ESV can potentially change the hemodynamic condition of the gastrosplenic region, but no evidence indicates upper GI bleeding is the late complication for SpDP-ESV.