同种异体静脉置换在腹部外科临床中的应用

Allogeneic vein replacement in abdominal surgery

目的评价同种异体静脉置换在腹部外科应用的围手术期安全性及远期效果。方法回顾性分析本中心2013年1月至2020年12月收治的115例术中行同种异体静脉置换患者的临床资料,分析围手术期并发症以及远期置换血管狭窄情况。结果本组患者均顺利完成手术,最常见术式为胰腺癌根治性胰十二指肠切除术(75.7%),最常见置换血管部位依次为门静脉-脾静脉-肠系膜上静脉汇合部(53.9%)、肠系膜上静脉(23.5%)、门静脉(18.3%)。本组患者围手术期死亡6例(5.2%),发生并发症31例(27.0%),与置换血管直接相关并发症包括门静脉血栓形成2例(1.7%)。随访期间置换血管发生轻度狭窄8例(7.5%),中度狭窄12例(11.5%),重度狭窄14例(13.2%)。置换血管中重度狭窄半年、1年、2年发生率分别为8.0%、24.4%、34.5%。结论采用同种异体静脉血管术中重建腹部大静脉短期、中期效果良好,术后抗凝治疗或可降低血栓形成或狭窄的发生率。

Objective To evaluate the perioperative safety and long-term prognosis of allogeneic vein replacement in abdominal surgery.Methods Clinical data of 115 patients receiving allogeneic vein replacement from Jan 2013 to Dec 2020 was retrospectively analyzed.Results The most common operation was radical pancreatoduodenectomy for pancreatic cancer(75.7%),and the most common vascular replacement sites were the junction of portal vein system(53.9%),followed by superior mesenteric vein(23.5%)and portal vein(18.3%).In our group,6 patients died(5.2%),31 patients had complications(27.0%),and 2 patients had portal vein thrombosis(1.7%).During the follow-up period,8 cases(7.5%)had mild stenosis,12 cases(11.5%)had moderate stenosis and 14 cases(13.2%)had severe stenosis.The half-year,one-year and two-year incidence of moderate and severe stenosis were 8.0%,24.4%and 34.5%respectively.Conclusions The early and mid-term result of allogeneic vein replacement is satisfactory.Use of postoperative anticoagulation may help reduce the incidence of thrombogenesis or stenosis.