联合肠系膜上/门静脉汇合部胰十二指肠切除术后左侧门静脉高压症的研究现状

Current research status of left-sided portal hypertension after superior mesenteric-portal vein confluence pancreaticoduodenectomy

外科手术是胰腺癌最主要的治疗手段,临床上胰腺癌进行根治性外科手术时,往往需要联合肠系膜上/门静脉汇合部胰十二指肠切除术以期达到R0切除。然而,进行脾静脉离断术后可能会并发严重的左侧门静脉高压症(LSPH),进而产生一系列病理性改变,如脾脏淤血性肿大、血小板降低、脾静脉流域回流受阻并发胃肠道静脉曲张,更有甚者会出现致命性消化道大出血、失血性休克。因此,为了临床上更好地处理LSPH,本文旨在对联合肠系膜上/门静脉汇合部胰十二指肠切除术后LSPH发生机制、治疗方案以及防治策略进行系统性分析回顾,并基于当前的研究提出相应建议。

Surgical operation is the main treatment method for pancreatic cancer,and in clinical practice,radical surgery for pancreatic cancer is often combined with superior mesenteric-portal vein confluence pancreaticoduodenectomy to achieve R0 resection.However,severe left-sided portal hypertension(LSPH)may occur after splenic vein dissection,resulting in a series of pathological changes such as congestive splenomegaly,thrombocytopenia,backflow obstruction of splenic vein,and gastrointestinal varices,and in some cases,it can lead to fatal gastrointestinal hemorrhage and hemorrhagic shock.Therefore,in order to better manage LSPH in clinical practice,this article systematically analyzes and reviews the pathogenesis,treatment regimens,and control strategies of LSPH after combined superior mesenteric-portal vein confluence pancreaticoduodenectomy and put forward corresponding suggestions based on current studies.