背景:肝外门静脉阻塞的原因包括腹部手术,如胰十二指肠切除术。我们改善了胰十二指肠切除术后由于肝外门静脉阻塞引起的空肠静脉曲张出血,通过睾丸静脉分流.
方法:一名72岁的男性在5年前被诊断为肝外胆管癌,并接受了保留胃的胰十二指肠切除术。术后无并发症发生,使用盐酸吉西他滨进行辅助化疗,患者仍无复发。术后1年6个月,出现肝外门静脉狭窄,但没有发现复发。然而,4年零6个月后,反复发生消化道出血,患者被诊断为肝外门静脉阻塞。双气囊小肠镜检查显示肝空肠吻合术区毛细血管扩张和静脉曲张,并诊断出侧支血管静脉出血。进行了肠系膜上静脉到右睾丸静脉分流术,随后胃肠道出血消失,贫血改善了.尽管发生了一过性肝性脑病,保守治疗缓解了它。双气囊小肠镜证实异常血管消失。
结论:使用右睾丸静脉的门体分流手术有效地缓解了胰十二指肠切除术后由于肝外门静脉阻塞引起的空肠肝管空肠吻合部位周围的难治性静脉曲张出血。
BACKGROUND: Causes of extrahepatic portal vein obstruction include abdominal surgeries such as pancreaticoduodenectomy. We improved jejunal variceal bleeding due to extrahepatic portal vein occlusion after pancreaticoduodenectomy, by shunting of the testicular vein.
METHODS: A 72-year-old man was diagnosed with extrahepatic bile duct cancer and underwent subtotal stomach-preserving pancreaticoduodenectomy 5 years ago. No postoperative complications occurred, adjuvant chemotherapy using gemcitabine hydrochloride was performed, and the patient remained recurrence-free. One year and 6 months post-operation, extrahepatic portal vein stenosis appeared, but no recurrence was noted. However, 4 years and 6 months later, recurrent gastrointestinal bleeding occurred, and the patient was diagnosed with an extrahepatic portal vein obstruction. Double-balloon enteroscopy showed capillary dilatation and varicose veins in the hepaticojejunostomy region, and venous bleeding from collateral blood vessels was diagnosed. A superior mesenteric vein to the right testicular vein shunt operation was performed, following which the gastrointestinal bleeding disappeared, and the anemia improved. Although transient hepatic encephalopathy occurred, conservative treatment relieved it. Double-balloon enteroscopy confirmed the disappearance of abnormal blood vessels.
CONCLUSIONS: A portosystemic shunt operation using the right testicular vein effectively relieved refractory variceal bleeding around the hepaticojejunostomy site in the jejunum due to an extrahepatic portal vein obstruction after pancreaticoduodenectomy.