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中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 241 -244. doi: 10.3877/cma.j.issn.1674-0793.2023.04.001

专家论坛

异体静脉置换技术在门静脉系统切除重建术中的临床应用
郎韧(), 黄金灿, 吕少诚, 贺强   
  1. 100020 首都医科大学附属北京朝阳医院肝胆外科
  • 收稿日期:2022-09-30 出版日期:2023-08-01
  • 通信作者: 郎韧

Application of allogenic vascular replacement technique in the reconstruction of portal venous system

Ren Lang(), Jincan Huang, Shaocheng Lyu   

  • Received:2022-09-30 Published:2023-08-01
  • Corresponding author: Ren Lang
引用本文:

郎韧, 黄金灿, 吕少诚, 贺强. 异体静脉置换技术在门静脉系统切除重建术中的临床应用[J/OL]. 中华普通外科学文献(电子版), 2023, 17(04): 241-244.

Ren Lang, Jincan Huang, Shaocheng Lyu. Application of allogenic vascular replacement technique in the reconstruction of portal venous system[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(04): 241-244.

门静脉由肠系膜上静脉和脾静脉在下腔静脉前方、胰颈后方汇合而成,收集大部分腹部脏器及消化道的静脉回流。由于其特殊的解剖位置,胰腺癌、远端胆管癌、腹膜后肿物等多种腹部恶性肿瘤均可能侵及门静脉系统,有资料显示30%~40%胰腺癌患者就诊时已存在血管受侵[1,2],既往文献报道2.4%~17.5%远端胆管癌患者需联合门静脉系统切除重建[3]。目前,肿瘤联合受侵静脉切除已得到国内外指南的广泛认可[4,5],可以进一步提升手术R0切除率,改善患者远期生存。然而,由于不同个体肿瘤对门静脉系统侵袭的部位及范围存在差异,如何合理利用血管移植物,处理不同门静脉系统受侵情况,仍是外科手术的难点。而血管移植物的选择目前也尚未达成共识,异体静脉作为主要血管移植物之一,在血管切除重建中有其独有优势,本文结合中心行异体静脉置换的经验,旨在总结异体静脉置换技术在门静脉系统切除重建术中的临床应用。

图1 不同形态异体静脉置换手术 A为补片异体静脉(黑色箭头)置换;B为管状异体静脉(黑色箭头)置换;C为单分支异体静脉(黑色箭头)置换;D为多分支异体静脉(黑色箭头)置换;AV:异体静脉;PV:门静脉;SMV:肠系膜上静脉;SV:脾静脉;IVC:下腔静脉
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