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find Author "ZHANG Yajin" 1 results
  • Feasibility Study on Clinical Application of Hepatic Artery,Proper Hepatic Artery,and Internal Iliac Vein Resection and Reconstruction in Extended Pancreaticoduodenectomy

    Objective To explore the feasibility of clinical application of hepatic artery (HA) or proper hepatic artery (PHA) anastomosing with superior mesenteric artery (SMA) and internal iliac vein (IIV) anastomosing with superior mesenteric vein (SMV) or portal vein (PV) in the extended pancreaticoduodenectomy combined with vascular resection.Methods The HA,PHA,SMA, SMV, PV, and IIV were dissected on 20 adult corpses, and the length, thickness,and lumen diameter of blood vessels were measured and compared with the results of multislice spiral CT scan,magnetic resonance angiography,or color Doppler in 25 patients with pancreatic head carcinoma.The extended pancreaticoduodenectomy was carried out on 5 patients of pancreatic head carcinoma with vascular invasion according to the mathcing results,and the reconstructions of HA or PHA with SMA and IIV with SMV or PV were performed.Results According to autopsy,HA-PHA was (5.50±1.50) cm in length,(0.20±0.01) mm in thickness,(5.02±1.32) mm in lumen diameter;and SMA was (4.00±1.00) cm in length,(0.21±0.01) mm in thickness,(6.05±1.06) mm in lumen diameter.The lumen diameter of left IIV,right IIV,and PV or SMV was (11.06±0.16) mm,(11.10±0.13) mm,and (11.56±0.20) mm,respectively.The thickness of left IIV,right IIV,and PV or SMV was (0.10±0.01) mm,(0.10±0.02) mm,and (0.10±0.02) mm,respectively.The multislice spiral CT scan,magnetic resonance angiography,color Doppler,and selective arteriography in vivo showed that the thickness and lumen diameter of HA-PHA and SMA were wider (0.1 mm and 0.3 mm) than those of the autopsy results,and there were no statistic significances (P>0.05),but the length of HA-PHA was longer (1-2 cm) than that of SMA,and there was statistic significance (P<0.05). The survival of 5 patients with extended pancreaticoduodenectomy combined with PHA or SMA and IIV-PV/SMV resection and reconstruction was longer than that of palliative surgery patients or giving-up patients at the same period,and no long-term complications occurred.Conclusions The vascular invasion of pancreatic head carcinoma is not an absolute contraindication of radical pancreaticoduodenectomy.The survival of 5 patients with vascular invasion of pancreatic head carcinoma in this group is prolonged by extended pancreaticoduodenectomy combined with vascular resection and reconstruction as compared with palliative surgery group at the same period.HA,PHA,and IIV are the best autologous vascular alternative materials without more complications. Being familiar with regional anatomy will guide the surgeons in extended pancreaticoduodenectomy.

    Release date:2016-09-08 10:36 Export PDF Favorites Scan
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