背景:食管切除术后胰十二指肠切除术技术难度大,因为胃导管的血流应该被保存。腹腔轴狭窄(CAS)也是胰十二指肠切除术的一个问题,因为肝脏的动脉供血主要来自肠系膜上动脉(SMA)经胃十二指肠动脉(GDA)的侧支途径。在这里,我们报道了1例胰头癌患者,该患者在食管切除合并CAS后接受了胰十二指肠切除术.
方法:一名患有胰头癌的76岁男子被转诊到我们部门。他有食管切除术和胸骨后胃导管重建食管癌的病史。计算机断层扫描显示严重的CAS和SMA和脾动脉(SPA)之间的侧支途径扩张。我们根据术中发现准备了几种手术选择,并进行了根治性胰十二指肠切除术,同时切除了远端胃导管。残余胃导管的右胃上皮动脉(RGEA)从左中结肠动脉(MCA)供入,并进行微血管吻合。尽管CAS,当GDA被解剖和夹住时,良好的血流得到证实,和适当的肝动脉不需要重建。患者在术后第90天出院。
结论:我们成功地在食管癌切除术后进行了根治性胰十二指肠切除术,根据术中发现准备了多种手术选择。
BACKGROUND: Pancreaticoduodenectomy after esophageal resection is technically difficult, because blood flow of the gastric conduit should be preserved. Celiac axis stenosis (CAS) is also a problem for pancreaticoduodenectomy, because arterial blood supply for the liver comes mainly through the collateral route from the superior mesenteric artery (SMA) via the gastroduodenal artery (GDA). Herein, we report the
case of a patient with pancreatic head cancer who underwent a pancreaticoduodenectomy after esophagectomy with concomitant CAS.
METHODS: A 76-year-old man with pancreatic head cancer was referred to our department. He had a history of esophagectomy with retrosternal gastric conduit reconstruction for esophageal cancer. Computed tomography showed severe CAS and a dilated collateral route between the SMA and the splenic artery (SPA). We prepared several surgical options depending on the intraoperative findings, and performed radical pancreaticoduodenectomy with concomitant resection of the distal gastric conduit. The right gastroepiploic artery (RGEA) of the remnant gastric conduit was fed from the left middle colic artery (MCA) with microvascular anastomosis. Despite CAS, when the GDA was dissected and clamped, good blood flow was confirmed, and the proper hepatic artery did not require reconstruction. The patient was discharged on postoperative day 90.
CONCLUSIONS: We successfully performed radical pancreaticoduodenectomy after esophagectomy with concomitant CAS, having prepared multiple surgical options depending upon the intraoperative findings.