目的 探讨胰头癌侵犯肠系膜上动脉时行根治性切除的可行性。方法 采用联合将受侵犯的肠系膜上动脉一并切除的胰十二指肠切除术，肠系膜上动脉断端与腹主动脉端侧吻合方式重建。 结果 患者术后恢复顺利，已随访14个月，仍存活。 结论 肠系膜上动脉侵犯的胰头癌仍可行扩大的胰十二指肠切除术，并可延长患者的生存时间和提高生活质量。
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.
ObjectiveTo explore the prevalence and adjacency of the tributaries of superior mesenteric vessel. MethodsThis study is a prospective study. The patients with right-sided colonic malignant tumor who underwent laparoscopic complete mesocolon excision at the Division of Colorectal Surgery of Peking Union Medical College Hospital from July 2016 to September 2022 were collected. The real-time observation and evaluation of vascular anatomy was performed by the operator and recorded by a resident. The continuous variables without a normal distribution were summarized as median (P25, P75). The categorical variables were presented as number (%). ResultsA total of 200 patients were enrolled, including 114 males and 86 females, with an age of 63.5 (53.5, 72.0) years. The prevalence of ileocolic artery and vein was 98.0% (196/200) and 98.5% (197/200), respectively. There were 168 (86.2%) cases of the ileocolic vein accompanied the course of the ileocolic artery at the origin in 195 patients with simultaneous presence of ileocolic artery and vein. The right colic artery and vein was present in 39.5% (79/200) and 18.5% (37/200) patients, respectively. The prevalence of the middle colic artery and vein was 96.5% (193/200) and 90.5% (181/200), respectively. And the prevalence of the middle colic vein accompanied the path of the middle colic artery at the root was 67.8% (118/174) in the 174 patients with simultaneous presence of middle colic artery and vein. The trunk length of the middle colic artery was 2.2 (1.6, 3.2) cm. The Henle trunk was present in 185 (92.5%) cases, with a trunk length of 1.00 (0.50, 1.40) cm, and its lower edge was 2.80 (2.20, 3.30) cm from the junction of the pancreatic head and the horizontal part of the duodenum.ConclusionsThe results from the data analysis of this study suggest that the ileocolic artery and vein are present most constantly with a high incidence of the ileocolic vein accompanied the course of the ileocolic artery at the origin of superior mesenteric vessels. Therefore ileocolic artery and vein are expected to serve as an optimal anatomical landmarks for the caudal-to-cranial medial approach in laparoscopic complete mesocolon excision.
ObjectiveTo explore the feasibility and safety of modified semi-ex vivo small intestinal autotransplantation (IAT) in patients with distal cholangiocarcinoma (CC) involving mesenteric root. MethodThe clinicopathologic data of the patient with relapse after CC surgery admitted to Sichuan Provincial People’s Hospital on October 2022 were retrospectively analyzed. ResultsThe patient was a 40 years old male. The preoperative imaging showed that the superior mesenteric artery (SMA) and jejunal artery was surrounded by the tumor. The preoperative condition was good and the heart, lung, liver, and kidney functions were normal. The patient could tolerate surgery, then the modified semi-ex vivo IAT was performed. The patient recovered well after surgery and discharged on the 14th postoperative day. The postoperative pathological diagnosis result showed that it was CC. The patient was well and without recurrence or metastasis during following-up in the outpatient service for 5 months until April 2023. ConclusionsFrom the retrospective analysis of this case, it can be realized that the modified semi-ex vivo IAT for patients with tumor involving themesenteric root, it is safe and feasible. A treatment option can be provided for such patient.
Objective To compare efficacy of laparoscopic and open duodenal circular drainage operation for superior mesenteric artery compressing syndrome (SMACS). Methods From December 2012 to December 2015, the clinical data of 23 cases of laparoscopic duodenal circular drainage operation (laparoscope group) and 28 cases of open duodenal circular drainage operation (open group) were analyzed. The operation time, intraoperative bleeding, postoperative ambulation time, postoperative analgesics usage, postoperative the first exhaust time, postoperative the first feeding time, postoperative hospitalization time and postoperative incidence of complications were compared. The patients were followed up to confirm the effect after the operation. Results There were no differences of the age, sex, and body weight index between the laparoscope group and the open group (P>0.05). The operation time had no significant difference between these two groups (P>0.05). Compared with the open group, the intraoperative bleeding was less (P<0.05), the postoperative ambulation time, postoperative the first exhaust time, postoperative the first feeding time, postoperative hospitalization time were shorter (P<0.05), the rates of postoperative analgesics usage, incision infection, pulmonary infection, and intestinal obstruction were lower (P<0.05) in the laparoscope group. The rates of anastomotic leakage and anastomotic bleeding, and total postoperative complications rate had no significant differences between these two groups (P>0.05). All the patients were followed up for 8–36 months. The clinical symptoms disappeared and the body weight increased to normal level in the two groups. Conclusions Preliminary results of in this study show that laparoscopic duodenal circular drainage operation in treatment of SMACS has some advantages such as less trauma, faster recovery, fewer complications and shorter hospitalization time. Laparoscopy will be an ideal choice for treatment of SMACS.
ObjectiveTo introduce the advances in diagnosis and treatment of superior mesenteric artery syndrome (SMAS). MethodsLiteratures about SMAS published in domestic and abroad were collected and reviewed. ResultsSMAS was a rare medical condition characterized by acute or chronic ileus resulting from vascular compression of the third part of the duodenum by superior mesenteric artery. Images of upper gastrointestinal series, CT, MRI, and color Doppler ultrasonography were the major methods of diagnosing the syndrome and the upper gastrointestinal series was the most important. Conservative approaches were usually preferred to the treatment of SMAS. Surgery was performed on symptomatic patients when conservative treatment failed, and duodenojejunostomy was the best surgical procedure. ConclusionAwareness of the clinical and imaging features may be helpful to diagnosis and treatment of SMAS, and reasonable therapy shall include etiological treatment and relief of the obstruction by conservative treatment or surgery.
ObjectiveTo evaluate the application of artery first approach in pancreaticodudenectomy, aiming to explore superior mesenteric artery(SMA) and celiac axis in early stage of operation, confirming the resectability and achieving radical resection of the nervous and lymphatic tissues around axis of celiac artery and SMA. MethodsThe data of 27 patients with suspected carcinoma in pancreatic head who received the artery first approach in pancreaticodudenectomy from Sep, 2009 to Dec, 2013 in our hospital were retrospectively analyized. ResultsEight cases received palliative drainage operation, while other 19 cases received radical pancreatectomy, including 2 cases total pancreatectomy and 17 cases pancreaticodudenectomy, with 5 cases portal vein or superior mesenteric vein resection and reconstruction, 1 case common hepatic artery resection, and 2 cases extended right pancreatectomy. The operative time was(281.28±78.53) min(133-354 min), and amount of bleeding was(352±537) mL(189-1 352 mL). There were no operative death, and no reoperation due to complications. ConclusionArtery first approach is preferred for patients with borderline resectable tumors, pancreatic surgeon should be familiar to the various approach.
目的总结急性肠系膜上动脉缺血性疾病的外科治疗经验。 方法对黄石市中心医院2002年1月至2013年6月期间收治的41例急性肠系膜上动脉缺血性疾病患者的临床资料进行回顾性分析。 结果41例急性肠系膜上动脉缺血性疾病患者中，行手术治疗40例（术中死亡2例），行介入溶栓治疗1例。术后出现短肠综合征9例，死亡19例。出院后27例患者获访，随访时间为1周～2年（平均随访时间为1.4年）。随访期间，因家属放弃治疗而于家中死亡7例，转院后于他院死亡4例，3例未愈或复发，13例痊愈（1例行介入溶栓治疗）。 结论急性肠系膜上动脉缺血性疾病的不同进展阶段其临床特征有所差异，术前CT血管造影（CTA）检查的意义重大。早期诊断、早期治疗、根据病情不同阶段选择合适的治疗方案（手术、介入治疗、药物治疗等）是降低死亡率的关键。