背景:胰十二指肠切除术联合门静脉(PV)和/或肠系膜上静脉(SMV)切除术在胰胆管恶性肿瘤患者中已成为一种常见的手术方法。目前有各种移植物用于PV和/或SMV重建,但是这些移植物都有一定的局限性。因此,有必要探索具有广泛资源库的新型移植物,成本低,临床应用效果好,并且没有免疫反应排斥或对患者的额外损害。
目的:观察肝圆韧带(LTH)的解剖和组织学特征,并评估使用自体LTH移植物在胰胆管恶性肿瘤患者中的PV/SMV重建。
方法:在107例患者中,测量切除LTH标本的扩张后长度和直径。通过苏木精和伊红(HE)染色观察LTH标本的一般结构。胶原纤维(CFs),弹性纤维(EF),和平滑肌(SM)通过Verhoeff-VanGieson染色可视化,和CD34,VIII因子相关抗原(FVIIIAG)的表达,内皮型一氧化氮合酶(eNOS),使用免疫组织化学在LTH和PV(对照)内皮细胞中检测组织型纤溶酶原激活物(t-PA)。在26例胰胆管恶性肿瘤患者中使用自体LTH进行PV和/或SMV重建,并对结局进行回顾性分析.
结果:LTH的扩张后长度为9.67±1.43厘米,30cmH2O压力下的头端直径为12.82±1.32mm,尾端直径为7.06±1.88mm。在HE染色的LTH标本中发现了内皮细胞覆盖的光滑内膜的残留腔。EF的相对数量,LTH中的CFs和SM与PV中的CFs相似[EF(%):11.23±3.40vs11.57±2.80,P=0.62;CF(%):33.51±7.71vs32.11±4.82,P=0.33;SM(%):15.61±5.26vs16.74±4.83,P=0.32]。CD34,FVIIIAG,eNOS,t-PA在LTH和PV内皮细胞中均有表达。所有患者均成功完成PV和/或SMV重建。总体发病率和死亡率分别为38.46%和7.69%,分别。无移植相关并发症。术后2周静脉狭窄率,1个月,3个月和1年为7.69%,11.54%,15.38%和19.23%,分别。在所有受影响的5名患者中,血管狭窄程度小于重建静脉管腔直径的一半(轻度狭窄),这些船只仍然是专利。
结论:LTH的解剖和组织学特征与PV和SMV相似。因此,LTH可用作需要PV和/或SMV切除的胰胆管恶性肿瘤患者的PV和/或SMV重建的自体移植物。
BACKGROUND: Pancreaticoduodenectomy combined with portal vein (PV) and/or superior mesenteric vein (SMV) resection in patients with pancreaticobiliary malignancy has become a common surgical procedure. There are various grafts currently used for PV and/or SMV reconstruction, but each of these grafts have certain limitations. Therefore, it is necessary to explore novel grafts that have an extensive resource pool, are low cost with good clinical application, and are without immune response rejection or additional damage to patients.
OBJECTIVE: To observe the anatomical and histological characteristics of the ligamentum teres hepatis (LTH) and evaluate PV/SMV reconstruction using an autologous LTH graft in pancreaticobiliary malignancy patients.
METHODS: In 107 patients, the post-dilated length and diameter in resected LTH specimens were measured. The general structure of the LTH specimens was observed by hematoxylin and eosin (HE) staining. Collagen fibers (CFs), elastic fibers (EFs), and smooth muscle (SM) were visualized by Verhoeff-Van Gieson staining, and the expression of CD34, factor VIII-related antigen (FVIIIAg), endothelial nitric oxide synthase (eNOS), and tissue type plasminogen activator (t-PA) were detected using immunohistochemistry in LTH and PV (control) endothelial cells. PV and/or SMV reconstruction using the autologous LTH was conducted in 26 patients with pancreaticobiliary malignancies, and the outcomes were retrospectively analyzed.
RESULTS: The post-dilated length of LTH was 9.67 ± 1.43 cm, and the diameter at a pressure of 30 cm H2O was 12.82 ± 1.32 mm at the cranial end and 7.06 ± 1.88 mm at the caudal end. Residual cavities with smooth tunica intima covered by endothelial cells were found in HE-stained LTH specimens. The relative amounts of EFs, CFs and SM in the LTH were similar to those in the PV [EF (%): 11.23 ± 3.40 vs 11.57 ± 2.80, P = 0.62; CF (%): 33.51 ± 7.71 vs 32.11 ± 4.82, P = 0.33; SM (%): 15.61 ± 5.26 vs 16.74 ± 4.83, P = 0.32]. CD34, FVIIIAg, eNOS, and t-PA were expressed in both LTH and PV endothelial cells. The PV and/or SMV reconstructions were successfully completed in all patients. The overall morbidity and mortality rates were 38.46% and 7.69%, respectively. There were no graft-related complications. The postoperative vein stenosis rates at 2 wk, 1 mo, 3 mo and 1 year were 7.69%, 11.54%, 15.38% and 19.23%, respectively. In all 5 patients affected, the degree of vascular stenosis was less than half of the reconstructed vein lumen diameter (mild stenosis), and the vessels remained patent.
CONCLUSIONS: The anatomical and histological characteristics of LTH were similar to the PV and SMV. As such, the LTH can be used as an autologous graft for PV and/or SMV reconstruction in pancreaticobiliary malignancy patients who require PV and/or SMV resection.