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

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.