脾静脉闭塞后静脉侧支发展模式与胰腺远端切除术后的手术和肿瘤预后相关。

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Keishi Sugimachi, Tomonari Shimagaki, Takahiro Tomino, Emi Onishi, Yohei Mano, Tomohiro Iguchi, Masahiko Sugiyama, Yasue Kimura, Masaru Morita, Yasushi Toh
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引用次数: 0

摘要

目的:胰腺肿瘤引起的脾静脉闭塞(SpVO)可能导致侧支循环和左侧门静脉高压。本研究旨在探讨脾静脉闭塞对胰腺远端切除术(DP)的影响,并为此类病例的治疗提供见解:这项回顾性分析纳入了2014年至2022年期间接受胰腺切除术的124例患者。对88例因胰腺导管腺癌(PDAC)接受胰腺切除术的患者进行了亚组分析:26例(20.8%)患者发现了SpVO。SpVO患者的脾脏体积明显增大,血小板计数明显降低。与脾静脉(SpVs)通畅的患者相比,SpVO患者的手术时间明显更长(P = 0.006),术后并发症的发生率更高(P = 0.002)。我们将与 SpVO 相关的侧支途径分为五种模式。最常见的模式是左胃十二指肠静脉型,这与胰腺体肿瘤有关。在 PDAC 患者中,SpVO 与肿瘤较大、微血管渗透和腹膜复发有关。然而,SpVO患者与SpV通畅患者的总生存率和无复发生存率之间的差异并不显著:结论:SpVO 会导致左侧门静脉高压,可能成为 DP 围手术期并发症的风险因素。结论:SpVO 会导致左侧门静脉高压,可能成为 DP 围手术期并发症的风险因素。根据侧支血流模式分类制定手术计划有助于防止术中充血和围手术期并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Patterns of venous collateral development after splenic vein occlusion associated with surgical and oncological outcomes after distal pancreatectomy

Aims

Splenic vein occlusion (SpVO) due to a pancreatic tumor may result in the development of collateral circulation and left-sided portal hypertension. This study aimed to investigate the impact of SpVO on distal pancreatectomy (DP) and provide insights about the management of such cases.

Methods

This retrospective analysis included 124 patients who underwent DP from 2014 to 2022. A subgroup analysis was performed on 88 patients who underwent DP for pancreatic ductal adenocarcinoma (PDAC).

Results

SpVO was found in 26 (20.8%) patients. The patients with SpVO had significantly larger splenic volumes and lower platelet counts. Compared to the patients with patent splenic veins (SpVs), the patients with SpVO underwent significantly longer operations (p = 0.006), with a higher incidence of postoperative complications (p = 0.002). We classified the collateral routes associated with SpVO into five patterns. The most common pattern was the left gastroepiploic vein type, which was associated with a tumor of the pancreatic body. In patients with PDAC, SpVO was associated with larger tumors, microscopic vascular permeation, and peritoneal recurrence. However, the differences between overall and recurrence-free survival rates in the patients with SpVO vs those with patent SpVs were not significant.

Conclusions

SpVO causes left-sided portal hypertension, which can be a risk for perioperative complications in DP. Operative planning based on the classification of collateral flow patterns may help prevent intraoperative congestion and perioperative complications.

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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
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