Sinistral portal hypertension and distal splenorenal shunt during pancreatic surgery

• 作者: Tomohide Hori Ryuhei Aoyama Hidekazu Yamamoto Hideki Harada Michihiro Yamamoto Masahiro Yamada Takefumi Yazawa Masazumi Zaima
• 来源期刊: 国际肝胆胰疾病杂志（英文版）
• 年，卷（期）: 2022,（1）
• 所属期刊栏目: VIEWPOINTS
• 页码范围: 73-75
• 页数: 3页
• 语种: 英文

摘要

Locally advanced pancreatic cancer located in the head or un- cinate process ( i.e. , uncus) often invades the confluence of the superior mesenteric vein (SMV), portal vein (PV), and splenic vein (SV) [ 1 , 2 ]. Additionally, chronic pancreatitis easily occludes drainage flow via the SV [3] . These pancreatic diseases force sur- geons to perform en bloc resection of the SV. Simple ligation of the remnant SV without venous resection results in sinistral por- tal hypertension (PH) ( i.e. , left-sided PH), gastrointestinal bleeding, splenic congestion, and hypersplenism over the long term [ 1 , 2 ]. Postoperative sinistral PH is considered an intractable complication accompanied by refractory symptoms similar to those of PH due to liver cirrhosis [ 1 , 2 ]. Optimal management of the remnant SV is required during surgery [ 1 , 2 ]; however, intentional venous recon- struction for drainage flow of the SV is still controversial [ 1 , 2 , 4-8 ]. We herein focus on sinistral PH due to occlusion of drainage flow via the SV, present actual characteristics in typical cases of pancre- atic cancer and chronic pancreatitis, and discuss a strategic adap- tation of the distal splenorenal shunt (DSRS) procedure.