医学
肝十二指肠韧带
门(解剖学)
恶性肿瘤
胰十二指肠切除术
放射科
门静脉
门静脉系统
静脉
切除术
手术计划
外科
门脉高压
病理
肝硬化
胃肠病学
作者
Farzad Alemi,Flavio G. Rocha,W. Scott Helton,Thomas Biehl,Adnan Alseidi
出处
期刊:Hpb
[Elsevier]
日期:2016-10-01
卷期号:18 (10): 827-834
被引量:15
标识
DOI:10.1016/j.hpb.2016.05.015
摘要
Surgical resection is the only cure for hepato-pancreato-biliary (HPB) malignancy. In the era of multidisciplinary approaches and neoadjuvant therapies for locally advanced, borderline resectable tumors, the feasibility and efficacy of en bloc vascular resection has been validated across multiple studies. However, the variability of venous anatomy within the perihepatic and peri-portal regions necessitates familiarity with alternative resection and reconstruction techniques appropriate to the specific region of tumor invasion.To organize these paradigms, the venous system has been divided into five zones: 1) hepatic hilum; 2) hepatoduodenal ligament; 3) portal vein/splenic vein confluence, which is further subdivided into right (3a) and left (3b); 4) infra-confluence; and 5) splenic vein.This study systematically analyzes the anatomic considerations and clinical scenarios specific to each zone to organize the necessary preparative maneuvers, surgical procedures, and vascular reconstruction techniques to achieve an R0 resection. The anatomic and tumor-specific factors which deem a specimen unresectable are also explored. Surgical videos demonstrating these techniques are presented.Preparation and familiarity with venous reconstruction maneuvers is essential for an oncologically effective operation, and can be safely achieved by utilizing this logical anatomic and procedural framework.
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