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腹腔镜胰腺切除术中静脉重建方法的选择及预后

Selection and Prognosis of Different Venous Reconstruction Methods in Laparoscopic Pancreatectomy

  • 摘要: 胰腺癌是一种高度恶性、预后极差的消化系统肿瘤,其早期隐匿,发展迅速,确诊时经常侵犯周围重要血管,因此胰腺切除术中常需要联合门静脉和(或)肠系膜上静脉的切除重建。目前有多种静脉切除重建的方法,各有其优缺点和适用性,但总体相较开放手术,腹腔镜下胰腺手术对技术的要求更高,决策需求更加精准。为了促进腹腔镜胰腺切除术中静脉重建技术的进步,本文结合团队实践经验和文献报道对重建取材、操作难度、风险、近远期通畅性等方面进行了总结和评价,着重讨论了不同方式和材料的适用性。此外,针对术后重建静脉通畅性,介绍了本团队模仿冠状动脉通畅程度的评价模式所提出但尚未得到外部验证的“横截面积法”,用以精确定量术后静脉通畅情况。通过总结腹腔镜胰腺手术中静脉重建技术的选择和预后现状,未来有望提出腹腔镜胰腺手术静脉切除重建的技术规范,并个体化地评估患者术后静脉通畅情况,推动胰腺微创手术技术进步和提高患者的长期预后。

     

    Abstract: Pancreatic cancer is a highly malignant tumor of the digestive system and has an extremely poor prognosis. Due to its insidious onset and rapid progression, major surrounding vessels are frequently invaded at the time of diagnosis. Consequently, resection and reconstruction of the portal vein and/or superior mesenteric vein are often required during pancreatectomy. Various methods of venous resection and reconstruction have been developed, each with its own advantages, limitations, and specific applicability. Compared with open surgery, laparoscopic pancreatectomy requires higher technical proficiency and more precise intraoperative decision-making. To promote the advancement of venous reconstruction techniques in laparoscopic pancreatectomy, in this article, we summarize and evaluate our team’s practical experience and relevant literature, focusing on graft selection, technical difficulty, operative risk, and short- and long-term patency. Special emphasis was placed on the applicability of different approaches and materials. In addition, regarding postoperative reconstruction of venous patency, we introduced the “Cross-sectional Area Algorithm”, a method simulating the evaluation mode of coronary artery patency, to accurately quantify postoperative venous patency. The evaluation method was first proposed by the team but has not yet been externally validated. By reviewing the current status of venous reconstruction strategies and the prognosis of laparoscopic pancreatic surgery, we aim to inform the development of standardized technical guidelines, enable individualized assessment of venous patency after surgery, and ultimately improve minimally invasive pancreatic surgery and the long-term prognosis of patients.

     

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