同种异体髂总静脉及其属支“Y”形重建在长段门静脉-肠系膜上静脉受累胰腺癌中的应用

Application of Y-shaped reconstruction using allogeneic common iliac vein and its branches in pancreatic cancer with long-segment portal vein-superior mesenteric vein involvement

摘要:

背景与目的 胰腺肿瘤侵犯门静脉-肠系膜上静脉时，尤其受累长度超过5 cm，常难以通过端端吻合完成血管重建，限制R₀切除的实现。本研究探讨采用同种异体髂总静脉及其属支进行“Y”形重建在此类患者中的可行性及安全性。方法 回顾性分析2022年5月—2024年4月收治的2例门静脉-肠系膜上静脉长段受累的胰腺肿瘤患者临床资料。2例患者均行肿瘤及受累静脉整块切除，术中采用同种异体髂总静脉及其属支修剪成“Y”形，分别重建门静脉-肠系膜上静脉及门静脉-脾静脉通路。结果 2例患者手术均顺利完成，未发生围手术期严重并发症及静脉血栓形成。术后住院时间分别为27 d和23 d。患者1术后病理为胰腺实性假乳头状肿瘤，随访12个月无复发；患者2为胰腺低分化腺癌，术后4个月出现肝转移并死亡。术后影像学提示重建血管通畅，脾胃侧静脉回流良好。结论 对于门静脉-肠系膜上静脉受累长度超过5 cm的胰腺肿瘤，采用同种异体髂总静脉及其属支进行“Y”形重建，可在实现R₀切除的同时恢复肠侧及脾胃侧静脉回流，具有良好的可行性和短期安全性，但仍需大样本研究进一步验证。

Abstract:

Background and Aims When pancreatic tumors invade the portal vein-superior mesenteric vein, especially with involvement exceeding 5 cm, end-to-end anastomosis is often not feasible, limiting the achievement of R₀ resection. This study aimed to evaluate the feasibility and safety of using allogeneic common iliac vein and its branches for Y-shaped vascular reconstruction.Methods A retrospective analysis was conducted on two patients with pancreatic tumors involving long-segment portal vein-superior mesenteric vein treated between May 2022 and April 2024. Both patients underwent en bloc tumor and venous resection. Allogeneic common iliac vein with its branches was trimmed into a Y-shaped graft to reconstruct the portal vein-superior mesenteric vein and portal vein-splenic vein pathways.Results Both surgeries were successfully completed without major perioperative complications or venous thrombosis. The postoperative hospital stays were 27 and 23 days, respectively. Pathology revealed a solid pseudopapillary tumor in case 1 and poorly differentiated pancreatic adenocarcinoma in case 2. Case 1 remained recurrence-free at 12-month follow-up, whereas case 2 developed liver metastasis and died 4 months postoperatively. Postoperative imaging demonstrated good graft patency and effective restoration of splanchnic venous return.Conclusion For pancreatic tumors with portal vein-superior mesenteric vein involvement exceeding 5 cm, Y-shaped reconstruction using allogeneic common iliac vein and its branches is feasible and safe in the short term, enabling R0 resection while restoring both mesenteric and splenic venous return. Larger studies are needed for further validation.