Concomitant splenic artery ligation has no preventive effect on left‐sided portal hypertension following pancreaticoduodenectomy with the resection of the portal and superior mesenteric vein confluence for pancreatic ductal adenocarcinoma

Annals of Gastroenterological Surgery

Shugo Mizuno¹  Aoi Hayasaki¹  Kazuyuki Gyoten¹  Takahiro Ito¹  Masashi Kishiwada¹  Hiroyuki Sakurai¹  Yasuhiro Murata¹  Akihiro Tanemura¹  Naohisa Kuriyama¹  Motonori Nagata² 

[1] Department of Hepatobiliary Pancreatic and Transplant Surgery Mie University School of Medicine Tsu Japan;Department of Radiology Mie University School of Medicine Mie University School of Medicine Tsu Japan;

关键词: left‐sided portal hypertension;    plenic artery ligation;    splenic vein division;    splenomegaly;    thrombocytopenia;    varices;   

DOI  :  10.1002/ags3.12545

来源: DOAJ

【 摘 要 】

Abstract Background Left‐sided portal hypertension (LSPH) caused by splenic vein (SV) division in pancreaticoduodenectomy (PD) with portal vein (PV) resection remains challenging. The current study aimed to investigate the efficacy of splenic artery (SA) ligation in preventing LSPH. Methods One‐hundred thirty patients who underwent PD with PV resection for pancreatic ductal adenocarcinoma were classified into SV and SA preservation (SVP, n = 30), SV resection and SA preservation (SVR, n = 59), and SV resection and SA ligation (SAL, n = 41). The postoperative incidence of LSPH was assessed. Results The incidence of variceal formation in SVP, SVR, and SAL were 4.8%, 53.2%, and 46.4% at 3 mo, 13.0%, 71.2%, and 62.5% at 6 mo, and 25.0%, 87.5%, and 87.1% at 12 mo, respectively. The rate was significantly higher in SVR at 3 and 6 mo (P = .001 and P < .001, respectively) and in SVR and SAL (P < .001) at 12 mo. Variceal hemorrhage occurred only in SVR (n = 4). The platelet count ratio at 3, 6, and 12 mo began to significantly decrease from 3 mo in SVR (0.77, 0.67, and 0.60, respectively; P < .001) and 6 mo in SAL (0.91, 0.73, and 0.69, respectively; P < .001). The spleen volume ratio also showed significant increase from 3 mo in SVR (1.24, 1.34, and 1.42, respectively; P < .001) and 6 mo in SAL (1.31, 1.32, and 1.34, respectively; P < .001). SVR and SAL were significant risk factors for variceal formation at 12 mo (odds ratio, 21.0 and 20.3, respectively). Conclusion In PD with PV resection, SAL delayed LSPH but could not prevent its occurrence.

【 授权许可】

Unknown