左肾静脉：胰腺手术的最佳间置移植物？

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-05-01 DOI:10.1016/j.hpb.2025.01.004

Ahmer Irfan, Peter Kim, Farah Ladak, David Chan, Sean Cleary, Carol-Anne Moulton, Gonzalo Sapisochin, Trevor Reichman, Chaya Shwaartz, Ian McGilvray

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引用次数: 0

摘要

背景：门静脉-肠系膜静脉切除术（PMVR）是晚期胰腺癌的一种治疗方法。当一期吻合不可行时，可采用间置移植物。在我们中心，左肾静脉（LRV）是首选。方法：回顾性分析6年来接受胰腺切除术的患者。患者接受LRV收获PMVR介入移植物被确定。所有患者在术后第1天接受CT增强扫描以评估门静脉血栓形成。结果：183例患者行PMVR胰腺切除术。41例患者采用LRV移植。10例出现严重并发症。在指数手术后90天内有2例死亡，出院后30天内有6例再入院。4例患者术后出现静脉血栓。POD1时血清肌酐升高15.7%，最高达30.8%。大多数患者的血清肌酐恢复到术前肌酐的10%或更高。结论：我们提出了使用LRV作为PMVR的间置移植物的最大系列。我们建议将LRV作为首选的介入移植物。这种移植不会引起长期肾功能障碍，避免了额外切口的并发症。

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The left renal vein: the optimal interposition graft for pancreatic surgery?

Background

Porto-mesenteric venous resection (PMVR) is employed for advanced pancreatic cancer. When primary anastomosis is not feasible, an interposition graft can be used. At our centre, the left renal vein (LRV) is the preferred choice.

Methods

A retrospective analysis of patients undergoing pancreatic resection was performed over a 6-year period. Patients who underwent LRV harvest for a PMVR interposition graft were identified. All patients underwent a contrast-enhanced CT scan on post-operative day 1 to assess for portal vein thrombosis.

Results

Pancreatic resection with PMVR was performed in 183 patients. LRV graft was used in 41 patients. Severe complications were observed in 10 patients. There were two deaths within 90 days of the index operation and six readmissions within 30 days of discharge. Post-operative PV thrombus was observed in 4 patients.

The serum creatinine increased by 15.7 % on POD1 and peaked at 30.8 %. The majority of patients had returned to a serum creatinine within 10 % or better of their pre-operative creatinine.

Conclusion

We present the largest series using the LRV as an interposition graft for PMVR. We propose that the LRV should be used as the first-choice interposition graft. This graft does not cause long-term renal dysfunction and avoids the morbidity of an additional incision.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).