TIAN Wu 1,2 , GU Haitao 1 , SUN Hongcheng 1 , HUANG Li 1 , CHEN Guoqing 1 , ZHONG Lin 1
  • 1. Department of Hepatobiliary and Pancreatic Surgery, Shanghai General Hospital, Shanghai 200080, P. R. China;
  • 2. Department of General Surgery, Orthopaedics Hospital of Guizhou Province, Guiyang 550002, P. R. China;
ZHONG Lin, Email: zhonglin1@medmail.com.cn
pancreatic head cancer; pancreaticoduodenectomy; vascular graft reconstruction; portal vein; superior mesenteric vein
10.7507/1007-9424.201806025
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Objective  To summary the clinical effect of a special method of vascular reconstruction in pancreaticoduodenectomy (PD) combined with portal vein (PV) and superior mesenteric vein (SMV)/spleen vein(SV) confluence resection in the treatment of pancreatic head cancer with PV and SMV/SV confluence were both invaded by tumor. Methods  Retrospectively summarized the clinical data of 1 pancreatic head cancer patient who got treatment at Shanghai General Hospital in March 2017, whose PV and SMV/SV confluence were both invaded by tumor. According to the preoperative CT judgement, the degree of tumor and vascular infiltration was determined as type of Loyer E, the invasion part was located on the right wall of the SMV/SV confluence, and the depth of infiltration did not exceed the lowest point of the SMV/SV confluence junction. This patient underwent PD combined with the invasion of the PV and the right part of SMV/SV confluence resection, with the left part of SMV/SV confluence was retained, and then vascular graft was used for the anastomosis between the PV and the SMV/SV confluence. Results  The patient’s operative time was 380 min, and the blood loss was 200 mL. The blocking time of PV, SMV, and SV was 35, 30, and 30 min, respectively, without postoperative pancreatic fistula, biliary leakage, incision infection, pulmonary infection, vascular graft infection, blood clots, liver failure, and other complications. The patient recovered and discharged from hospital on postoperative twelfth day. In postoperative 1-month, the patient reviewed on abdomen CT angiography (CTA), showing the vascular graft unobstructed. In postoperative 3-, 6-, 9-, and 12-month, there was no obvious discomfort, and chest and abdominal CT found no tumor recurrence and metastasis in postoperative 12-months, as well as liver function was normal. Conclusions  For pancreatic head cancer with PV and SMV/SV confluence are both invaded by tumor, PD combined with the invasion of the PV and the right part of SMV/SV confluence resection, then the left part of SMV/SV confluence and PV are anastomosed by vascular graft, this is a special method of vascular reconstruction. It can reduce SV to reconstruct the anastomosis separately, shorten PV blocking time and the liver ischemia time, so it is very important in the rapid recovery of the liver function.

Citation： TIAN Wu, GU Haitao, SUN Hongcheng, HUANG Li, CHEN Guoqing, ZHONG Lin. The method of vascular reconstruction of pancreatic head cancer with portal vein and superior mesenteric vein/spleen vein confluence were both invaded by tumor. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(12): 1491-1495. doi: 10.7507/1007-9424.201806025 Copy

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