The impact of resection margin status within 1 mm clearance of portal and superior mesenteric vasculature on the prognosis of patients of pancreatic head adenocarcinoma undergoing pancreatoduodenectomy / 中华普通外科杂志

Objective:To evaluate the impact of resection margin status within a cut-off 1 mm clearance of cancer on the groove of portal/superior mesenteric vein and/or the top end of the uncinate process bordering on the superior mesenteric artery in pancreatic head adenocarcinoma patients after pancreatoduodenectomy.Methods:The clinical, pathological and followup data of 113 pancreatic head adenocarcinoma patients undergoing pancreatoduodenectomy with or without vascular graft replacement were retrospectively analyzed.Results:Univariate analysis showed that resection margin 1mm clearance, postoperative adjuvant chemotherapy, T staging, N staging, TNM staging (AJCC), gender, and maximum tumor diameter were risk factors for survival . Multivariate analysis showed that surgical margin 1mm clearance, postoperative adjuvant chemotherapy, and gender were independent prognostic factors. In resection margin >1 mm group(83 cases), the mean survival time was 19.04 months, and the 1-year, 2-year, and 3-year survival rates were 78%, 50%, and 25%, respectively. In resection margin ≤1 mm group(30 cases), the mean survival time was 9.42 months, and the 1-year, 2-year and 3-year survival rates were 61%, 20% and 0, respectively. There was statistical significance between the two groups in survival time ( P=0.018). Conclusion:Resection margins 1 mm clearance of cancer off portal vein/superior mesenteric vein and superior mesenteric artery is independent prognostic factors in pancreatic head adenocarcinoma patients undergoing pancreatoduodenectomy.

Ascending Colon Cancer with Pathologically Confirmed Tumor Thrombosis of Superior Mesenteric Vein: A Case Report

Colon cancer is very rarely accompanied by tumor thrombosis of the superior mesenteric vein (SMV). A 46-year-old patient had been diagnosed with SMV tumor thrombosis related to colon cancer without hepatic metastasis and underwent right hemicolectomy with SMV tumor thrombectomy. Tumor thrombosis was pathologically confirmed as metastatic colon cancer. There has been no recurrence for 12 months with 12 cycles of adjuvant-chemotherapy.

Surgical feasibility of laparoscopic D3 lymphadenectomy along the left of SMA for right colon cancer / 中国实用外科杂志

OBJECTIVE: To investigate the feasibility and short-term outcomes of laparoscopic D3 lymphadenectomy along the left of SMA for right colon cancer.METHODS: The clinical data of 134 patients with right colon cancer admitted from June 2015 to March 2017 in Department of Gastrointestinal Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. A total of 57 patients received the laparoscopic D3 lymphadenectomy along the left of SMA and 77 patients received the laparoscopic D3 lymphadenectomy along the left of SMV.RESULTS: There was no statistical difference between the two groups in operation time,intra-operative blood loss,time of liquid intake and post-operative hospital stay,but the SMA group had a longer duration of tube drainage and larger total volume of drainage[(471.4±285.6)mL vs.(352.2±305.7)mL,(7.0±4.9)d vs.(5.7±2.0)d,P=0.02 和 P=0.03]. The SMA group harvested more lymph nodes than the SMV group(26.5±6.7 vs. 21.3±7.8,P<0.0001). However,the SMA group had a higher rate of post-operative complications(28.1% vs. 13.0%, P=0.04).CONCLUSION: Laparoscopic D3 lymphadenectomy along the left side of SMA for right colon cancer is feasible but had a higher rate of post-operative complications.

Clinical efficacy of pancreaticoduodenectomy using artery first approach and prior portal vein-superior mesenteric vein shunting and reconstruction for complicated pancreatic head tumors / 中华消化外科杂志

Objective To investigate the clinical efficacy of pancreaticoduodenectomy using artery first approach and prior portal vein (PV)-superior mesenteric vein (SMV) shunting for complicated pancreatic head tumors.Methods The retrospective cohort study was conducted.The clinicopathological data of 91 patients with pancreatic head cancer who were admitted to the Changhai Hospital of Navy Medical University from February 2011 to December 2016 were collected.Among 91 patients undergoing pancreaticoduodenectomy combined with vascular resection and reconstruction,27 using artery first approach and PV-SMV shunting and reconstruction were allocated into the PD-PVR group,23 using conventional approach were allocated into the PD-CVR group,and 41 receiving pancreaticoduodenectomy with vascular resection were allocated into the PD-SVR group.Observation indicators:(1) comparison of intra-and post-operative situations among groups;(2) comparison of postoperative pathological results among groups;(3) comparison of postoperative survival among groups.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to December 2017.Comparisons among groups of count data were done by the chi-square test or Fisher exact probability.Measurement data with normal distribution were represented as x±s,comparisons among groups were analyzed using the ANOVA,and pairwise comparison was done using the LSD method.Measurement data with skewed distribution were described as M(Q),comparison among groups was analyzed using the Kurskal-Wallis rank sum test,and pairwise comparison was done using the paired comparison with adjusted P value.Ordinal data were compared using the nonparametric test.The survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method,and Log-rank test was used for survival analysis.Results (1) Comparison of intra-and post-operative situations among groups:operation time,time of hepatic inflow occlusion,volume of intraoperative blood loss,cases with intraoperative blood transfusion,length of PV or SMV removal,cases with vascular grafts,grading 1,2,3,4 and 5 of Clavien-Dindo classification of postoperative complications and duration of hospital stay were respectively (274±36)minutes,(22±7)minutes,1 661 mL (110 mL,3 800 mL),20,(5.6±1.4)cm,6,11,1,1,1,1,(20±7)days in the PD-PVR group and (281±41)minutes,(27±5)minutes,1 888 mL (176 mL,4 162 mL),18,(5.4±1.5) cm,3,1,8,2,0,0,(21±7)days in the PD-CVR group and (201± 36)minutes,(16±6)minutes,1052 mL (74 mL,3 926 mL),17,(3.2±2.0) cm,5,15,2,3,1,1,(13± 6)days in the PD-SVR group,with statistically significant differences among groups (F=37.060,34.530,x2=13.771,14.015,F=32.260,x2 =39.309,F =19.880,P＜0.05).Patients with postoperative complications were improved by symptomatic and supporting treatment.(2) Comparison of postoperative pathological results among groups:mnaximum tumour dimension was respectively (3.6± 1.3) cm,(4.0± 1.3) cm and (2.6± 1.3) cm in the PD-PVR,PD-CVR and PD-SVR groups,with a statistically significant difference among groups (F =7.845,P＜0.05).Cases with high-differentiated,moderate-differentiated and low-differentiated tumors of tumor differentiation,staging Ⅱ A and Ⅱ B of tumor staging,nerve invasion,positive lymph node,positive resection margins in neck of pancreas,bile duct and SMV were respectively 0,13,14,17,10,17,21,0,0,0 in the PD-PVR group and 1,12,10,10,13,15,19,1,0,0 in the PD-CVR group and 1,29,11,17,24,30,29,2,1,1 in the PD-SVR group,with no statistically significant difference among groups (x2 =4.122,3.306,0.902,1.214,P＞0.05).(3) Comparisons of postoperative survival among groups:of 91 patients,52 were followed up for 3.0-69.3 months,with a median time of 18.0 months and follow-up rate of 57.1％ (52/91),including 16 in the PD-PVR group and 14 in the PD-CVR group and 22 in the PD-SVR group.The median survival time,1-,2-and 3-year overall survival rates in 52 patients were respectively 16.6 months,63.5％,35.7％ and 26.8％.The survival time in the PD-PVR,PD-CVR and PD-SVR groups were respectively 12.3 months (3.9-69.3 months),15.0 months (3.0-63.3 months) and 20.0 months (6.0-65.2 months),with a statistically significant difference in survival among groups (x2=6.201,P＜0.05),and between PD-PVR and PD-SVR groups (x2 =4.412,P＜0.05).There was no statistically significant difference in survival between PD-PVR and PD-CVR groups (x2 =0.001,P＞0.05).Conclusion Pancreaticoduodenectomy using artery first approach and PV-SMV shunting and reconstruction for complicated pancreatic head tumors can reduce the time of hepatic inflow occlusion,it also contributes to the risk control of surgery for complicated pancreatic tumors,increases surgical safety and improves patients' prognosis.

Portal and superior mesenteric vein resection in radical pancreatectomy for pancreatic cancer / 中华消化外科杂志

Radical resection remains essential for prolonging survival and increasing the possibility of cure in pancreatic cancer.However,few patients are resectable at the time of diagnosis,with a portion of patients presenting with portal and superior mesenteric vein invasion and regarded as resectable or locally advanced disease.Venous resection in pancreatectomy enables achievement of tumor-free margins in patients with venous invasion.This review provides an overview of preoperative evaluation,resection and reconstruction types,vascular grafts selection,morbidity,mortality and survival in radical pancreatectomy with portal and superior mesenteric vein resection.

Postoperative nursing care of one patient with pancreatic cancer undergoing pancreaticoduodenectomy combined with resection of superior mesenteric vein and artificial vascular reconstruction / 中国实用护理杂志

Objective@#To summarize the postoperative nursing experience of 1 patient with pancreatic cancer who underwent pancreaticoduodenectomy combined with superior mesenteric vein resection and artificial vascular reconstruction.@*Methods@#The nursing measures included: paying attention to anticoagulation treatment and observing its effect, strengthening pain management, giving nutritional support, pertinent nursing care for gastroparesis, guiding quantitative respiratory treatment for patient, preventing the lack of trace elements during jejunitas.@*Results@#Through active and effective nursing, the patients were discharged smoothly forty-seven days after operation.@*Conclusions@#Through nursing of 1 patient with pancreatic cancer underwent pancreatoduodenectomy combined with superior mesenteric vein resection and artificial vascular reconstruction after surgery, nurses can improve the nursing skills and nursing observation ability, as well as the theoretical basis and practical experience for the future clinical work.

Trombosis venosa mesentérica: Reporte de caso / Mesenteric Venous Thrombosis: Case Report

La trombosis de la vena mesentérica superior, es una patología del grupo de las isquemias intestinales agudas; de sintomatología inespecífica y dificil diagnóstico. Que tiene baja frecuencia 5-10% de las isquemias intestinales agudas; pero una gran mortalidad 50-75%. Presenta síntomas y signos parecidos a otras patologías de origen abdominal y los estudios complementarios dan resultados inespecíficos por lo que se diagnostica tardía y erróneamente en muchas ocasiones. Caso clínico. Se analiza el caso de un paciente masculino de 27 años, sin antecedentes de relevancia, con isquemia mesentérica aguda, que cursó con dolor abdominal inespecífico de 2 días de evolución. Discusión. La isquemia mesentérica es una patología con elevada mortalidad, su pronóstco depende de la rapidez del diagnóstco y el tratamiento acertado y precoz. Conclusión. El retraso del diagnóstico y la terapéutica aumentan la mortalidad. Tiene mejor pronóstico si tiene un precoz y adecuado diagnóstico y tratamiento agresivo.

Upper mesenteric vein thrombosis is a disease of acute intestinal ischemia; of non-specific symptoms and dificult diagnosis. It has low incidence, 5-10% of acute intestinal ischemia; but 50-75% of mortality. It presents symptoms and signs similar to other pathologies of abdominal origin and the complementary studies give unspecific results for what is a late diagnosis and erroneous in many occasions. We present the case of a 27 year old male patent, with no relevant history, with acute mesenteric ischemia, who had 2 days of non- specific abdominal pain. Mesenteric ischemia is a disease with high mortality rate, its prognosis depends on the timing of diagnosis and early treatment. Delayed diagnosis and therapy increases mortality.

Laparoscopic pancreaticoduodenectomy with a novel artery first and uncinate process first approach through Treitz ligament / 中华外科杂志

Objective@#To explore the clinical effect of a novel artery first and uncinate process first approach for laparoscopic pancreaticoduodenectomy(LPD), emphasizing the left lateral and posterior dissection of uncinate process (UP) via Treitz ligament approach.@*Methods@#From April to November 2016, 18 patients received LPD with a novel approach in Pancreas Center of the First Affiliated Hospital with Nanjing Medical University. All patients were diagnosed as pancreatic head or peri-ampulla tumor, without major vessel invasion nor distant metastasis. For resection, routine caudal view was used in the first step, to dissect the anterior medial border between uncinate process and superior mesenteric vein(SMV). Lymphatic tissues were completely dissected form anterior surface of hepatoduodenal ligament. In the second step, left lateral view with camera from left para-umbilical trocar was used, Treitz ligament was incised, SMA root was exposed. After anticlockwise rotation and retraction of mesentery, the anatomic relationship between SMA trunk, inferior pancreaticoduodenal artery(IPDA), jejunal branch of SMV, and distal part of UP, could be perfectly exposed from left lateral view. SMA was dissected from its root until the position above the uncinate process and duodenum, IPDA was transected, distal part of UP was freed from SMA. In the third step, right lateral view and caudal view were alternatively used; proximal UP mesentery was completely dissected out from SMA root, CA root and posterior surface of hepatoduodenal ligament. Pancreaticoduodenectomy was completed in the forth step after transection of pancreatic neck and common hepatic duct.@*Results@#The SMA root and distal UP were successfully dissected out via Treitz ligament approach in all 18 patients, among them, distal UP was completely excised in 8 patients from left view. Postoperative pathology showed R0 resection rate in 69%. Postoperative complication included intra-abdominal hemorrhage in 1 patient, pancreatic fistula in 7 patients(6 cases with grade A and 1 case with grade B), delayed gastric emptying in 4 patients (2 cases with grade A, 2 cases with grade B). Average postoperative hospital stay was (15.5±6.8)days.@*Conclusion@#The novel artery first and uncinate process first approach through Treitz ligament could help surgeons to completely dissect the full length of meso-pancreas along celiac axis-SMA axis in LPD.

Establishment of a rat model of superior mesenteric venous thrombosis / 中国比较医学杂志

Objective To establish a rat model of superior mesenteric vein thrombosis by vein ligation and to simulate the pathological process of the disease, and to provide the basis for studies of its pathogenesis and treatment.Methods Ninety-six SPF male SD rats were randomly divided into three groups: Group A (sham operation group), group B (strangulation group) and group C (simple group), 32 rats in each group.Rats in group A were only opened the abdominal cavity but not blocked the blood supply.The rats were sacrificed at 8, 24, 48 and 72 h after operation.The rats in groups B and C were subjected to establish the strangulation and simple models by superior mesenteric vein thrombosis, respectively, and were sacrificed at 8, 24, 48 and 72 h after modeling.Histological changes (H&E staining) in the rat intestinal tissues were evaluated by a pathological scoring system.The levels of intestinal fatty acid binding protein (IFABP) and α-glutathione S-transferase (α-GST) were detected by ELISA.Results The rat model of mesenteric vein thrombosis was successfully established, with a success rate of 100% (96/96).The pathological analysis revealed that compared with the group A, different degrees of blood stasis and injuries were observed in the intestinal tissues of groups B and C, and the injury were gradually increased in the group B, while gradually reduced in the group C.The degrees of blood stasis and injury were positively correlated with the scope of ligation.The result of ELISA showed that the serum levels of IFABP and α-GST of the rats in groups B and C were significantly higher than those in group A (P < 0.05), and the degree of elevation was positively correlated with the scope of ligation.Conclusions In this study, the rat model of superior mesenteric vein thrombosis is successfully established by vein ligation.This model is simple and easy to operate with a high success rate, and can be used in related research.

Rex shunt in pediatric prehepatic portal hypertension: a clinical analysis of 5 cases / 中华肝胆外科杂志

Objective To study the therapeutic efficacy of Rex shunt in treating pediatric patients with prehepatic portal hypertension (PHPH).Methods Five children with PHPH who were admitted from October 2014 to May 2015 were reviewed.There were three boys and two girls,with age ranging from 50 to 95.5 months [(75.8 ± 1.9) months].They all suffered from recurrent upper gastrointestinal (GI) bleeding.Their red blood cell (RBC),white blood cell (WBC) and platelet (PLT) counts were decreased,but laboratory findings revealed no liver dysfunction.Ultrasound and CT scan diagnosed cavernous transformation of portal vein (CTPV) and splenomegaly.The mean splenic length was (42.8 ± 8.2) cm.Indirect portal venography revealed patent left portal vein.All patients underwent Rex shunt and were followed up for 3 ～ 7 months.Results The mean duration of operation was (566.0 ± 39.7) min.Intraoperative bleeding varied from 10 to 50 ml.The portal pressure significantly decreased after surgery from [(25.6 ± 1.5) mmHg,1 mmHg =0.133 kPa] preoperatively to (19.2 ± 3.3) mmHg postoperatively (P ＜ 0.05).Portal venography indicated patent left portal vein after the Rex shunt.The postoperative course was uneventful in the five patients with a mean hospital stay of (26 ± 9.3) days.There was no further GI bleeding.The RBC,WBC and PLT counts increased.Ultrasound indicated patent anastomotic stomas and decreased splenic size.Conclusion A Rex shunt in treating patients with PHPH is safe,feasible and efficacious.

Pancreaticoduodenectomy combined with vascular resection and reconstruction for pancreatic head carcinoma / 中华消化外科杂志

Objective To investigate the clinical application value of pancreatoduodenectomy combined with vascular resection and reconstruction for pancreatic head carcinoma.Methods The clinical data of a patient with pancreatic head carcinoma who underwent pancreatoduodenectomy combined with vascular resection and reconstruction at the Southwest Hospital in March 2014 were retrospectively analyzed.Preoperative imaging examination showed no gap between vascular wall of portal vein (PV) and pancreatic head space-occupying lesion,vascular compression and stenosis at intersection of PV,splenic vein (SV) and superior mesenteric vein (SMV),but not excluding adjacent main PV invasion.During the operation,it was difficult to separate pancreatic head carcinoma from PV,indicating vascular wall invasion at intersection of PV,SV and SMV.Therefore,the pancreatic head,bile ducts,duodenum,partial jejunum,invasive vein vessels,lymphatic and nerve tissues were radically resected,then PV,SMV and SV were reconstructed.The patient was followed up by outpatient examination and telephone interview after surgery till April 2015.Results The patient underwent pancreatoduodenectomy combined with vascular resection and reconstruction successfully without blood transfusion.The operation time was 285 minutes and volume of intraoperative blood loss was 300 mL.The patient had a smooth postoperative recovery,resuming diet at postoperative day 5.The abdominal drainage tube and stitches were removed at postoperative day 6 and day 12,and the patient was discharged from hospital at postoperative day 15.Computed tomography reexamination showed clear vascular anastomose.The patient was not complicated with pancreatic fistula,biliary fistula,intra-abdominal hemorrhage and vascular embolism.The postoperative pathological examination confirmed the diagnosis of pancreatic head moderately differentiated adenocarcinoma accompanied by PV invasion and lymph node metastasis,with a negative margin.The patient began a course of single drug common chemotherapy using gemcitabine at postoperative day 40.No cancer recurrence was detected during the one-year follow-up.Conclusion Pancreatoduodenectomy combined with vascular resection and reconstruction is safe and feasible for the treatment of pancreatic head carcinoma with good surgical effects.

Catheter-directed thrombolytic therapy for acute superior mesenteric vein thrombus: comparison between via venous route and via arterial route / 介入放射学杂志

Objective To compare the clinical effects of catheter-directed thrombolytic therapy for acute superior mesenteric vein thrombus (SMVT) between via superior mesenteric vein (SMV) route and via superior mesenteric artery (SMA) route. Methods The clinical data of 32 patients with acute SMVT, who were treated with catheter-directed thrombolytic therapy at the Central Hospital of Shengli Oil Field, were retrospectively analyzed. Among the 32 patients, percutaneous transhepatic catheter-directed thrombolytic therapy via SMV route was performed in 23 (SMV group), and percutaneous transhepatic catheter-directed thrombolytic therapy via SMA route was carried out in 9 (SMA group). Results After the treatment, the clinical symptoms were significantly improved in 28 patients, including 22 of SMV group (95.7%) and 6 of SMA group (66.7%). CT angiography showed that the blood flow became almost complete patency in 17 patients of SMV group (73.9%) and in only 3 patients of SMA group (33.3%). Both the thrombolysis procedure time and X-ray exposure time of SMV group were obviously longer than those of SMA group. Conclusion Both via SMV and via SMA catheter-directed thrombolytic therapies are effective treatment for acute SMV thrombosis. The former is more effective, while the manipulation of the latter is technically simpler.

Research progress and experience on pancreaticoduodenectomy combined with vascular resection / 中华肝胆外科杂志

Pancreatic head carcinoma could easily invade the neighboring vessels due to its own biological features and anatomical location,which increases the technique difficulty and risk,leading to low resection rate.Recently,with the progress on the surgical techniques and perioperative management,and the emergence of neoadjuvant chemoradiation,vascular invasion is no longer the surgical contraindications and pancreaticoduodenectomy combined with vascular resection has saved many patients ' lives.However,the preoperative assessment,the timing of surgery,the vessel management during the surgery,and the prevention and treatment of the postoperative complications remain controversial.In order to achieve a clear understanding on the application of pancreaticoduodenostomy combined with vascular resection,here we review the recent publications and share the experiences on pancreaticoduodenectomy with portal and/or superior mesenteric vein resection from our center,which may help improve the safety and resection rate of pancreatic carcinoma and enhance the overall therapeutic efficacy of treating pancreatic cancer.

Superior mesenteric vein thrombosis accompanied with severe appendicitis

Superior mesenteric vein (SMV) thrombosis caused by acute appendicitis is a very rare entity nowadays. We report a successfully treated case of a 21-year-old man with SMV thrombosis associated with severe acute appendicitis. Intravenous heparin was administered, and it was later substituted with warfarin. Systemic antibiotic therapy was continued for 1 week, and it was substituted with oral antibiotics, which were administered for 3 weeks. On the 45th postoperative day, follow-up computed tomography scan demonstrated dissolution of SMV thrombosis. Anticoagulation therapy was maintained for 3 months. He was discharged without any complications. SMV thrombosis can be treated successfully with emergency appendectomy, broad-spectrum antibiotics, and anticoagulation therapy.

Risk factors for group 14v lymph node metastasis in advanced gastric cancer / 中华消化外科杂志

Objective To investigate the risk factors for group 14v lymph node metastasis in advanced gastric cancer.Methods The clinical data of 170 patients with advanced gastric cancer who were admitted to the Tianjin Cancer Hospital from January 2007 to December 2011 were retrospectively analyzed.All the patients received D2 gastrectomy + group 14v lymph node dissection.All the patients were with gastric adenocarcinoma.The general information of the patients,and the number of lymph node dissected and lymph node with positive expression were recorded.Univariate and multivariate analysis of clinicopathological factors influencing the group 14v lymph node metastasis were done using bivariate Logistic regression model.The correlation between the group 14v lymph node metastasis and regional lymph node metastasis was analyzed using the bivariate Logistic regression analysis.Results Of the 170 patients,459 group 14v lymph nodes were dissected,and 2.7 lymph nodes for each patient (range,1-17 lymph nodes) ; 55 positive lymph nodes were detected in patients with group 14v lymph node metastasis,and 1.7 lymph nodes for each patient (range,1-3 lymph nodes).The results of univariate analysis showed that group 14v lymph node metastasis was correlated with the degree of radical dissection of tumor,diameter of the tumor,lymph node metastasis (N stage) and distal metastasis (M stage).Compared with patients with advanced gastric cancer and with R0 resection of tumor,tumor diameter≤4 cm,N0 stages,and M0 stages,patients with R1 or R2 resection,tumor diameter ＞4 cm,N2 stages,N3 stages,and M1 stages had higher risk of group 14v lymph node metastasis (OR =3.899,2.646,19.231,33.929,5.000,95％ confidence interval:1.11113.677,1.075-6.516,2.333-158.548,4.310-267.112,1.617-15.464,P ＜ 0.05).The resnlts of multivariate analysis showed that N stage was the independent risk factor influencing the group 14v lymph node metastasis.Compared with patients in N0 stage,patients in N2 or N3 stage had higher risk of group 14v lymph node metastasis (OR =15.248,26.287,95％ confidence interval:1.811-128.386,3.244-213.034,P ＜ 0.05).Group 4sb,4d,5,6,7,8a,9,11p,12a and 16 lymph node mnetastasis were coxelated with group 14v lymph node metastasis (OR =3.923,3.335,2.693,5.641,3.100,4.203,3.655,3.660,3.838,17.400,95％ confidence interval:1.264-12.177,1.425-7.807,1.149-6.312,2.126-14.965,1.311-7.330,1.735-10.185,1.395-9.582,1.331-10.666,1.086-13.571,2.707-111.837,P ＜0.05).Conclusion N stage is an independent risk factor of group 14v lymph node metastasis,and the status of group 6 lymph node is the best indicator for group 14v lymph node metastasis.

Combination of Surgical Thrombectomy and Direct Thrombolysis in Acute Abdomen with Portal and Superior Mesenteric Vein Thrombosis

Portal vein (PV) thrombosis (PVT) is a rare condition with development of thrombosis in the PV and its branches. Further extension to the splenic and superior mesenteric vein (SMV) causes intestinal infarction, with a reported mortality of up to 50%. A variety of treatments for PVT exist including anticoagulation, thrombolysis, surgical thrombectomy, insertion of shunts, bypass surgery, and liver transplantation. We experienced a case of successfully treated by surgical thrombectomy with direct thrombolysis into the thrombosed-PV and SMV. A 31-year-old male presented worsening abdominal pain for one week. Preoperative contrast enhanced computed tomography scan revealed complete PVT extending to splenic vein and SMV. The PV was accessed surgically and opened by thrombectomy; visual inspection confirmed proximal and distal flow. Urokinase was administered directly into the inferior mesenteric vein with successful decrease in thrombus burden. The complete angiography showed complete dissolution of thrombosis in PV and SMV.

A Case of Successful Treatment of Portal Venous Gas Caused by Acute Pancreatitis / 대한소화기학회지

Hepatic portal venous gas (HPVG) has been considered a rare entity associated with a poor prognosis. Portal vein gas is most commonly caused by mesenteric ischemia but may have a variety other causes. HPVG can be associated with ischemic bowel disease, inflammatory bowel disease, intra-abdominal abscess, small bowel obstruction, acute pancreatitis, and gastric ulcer. Because of high mortality rate, most HPVG requires emergent surgical interventions and intensive medical management. We experienced a case of hepatic portal venous gas caused by acute pancreatitis and successfully treated with medical management.

Mesenteric Vascular Occlusion: Comparison of Ancillary CT Findings between Arterial and Venous Occlusions and Independent CT Findings Suggesting Life-Threatening Events

OBJECTIVE: To compare the ancillary CT findings between superior mesenteric artery thromboembolism (SMAT) and superior mesenteric vein thrombosis (SMVT), and to determine the independent CT findings of life-threatening mesenteric occlusion. MATERIALS AND METHODS: Our study was approved by the institution review board. We included 43 patients (21 SMAT and 22 SMVT between 1999 and 2008) of their median age of 60.0 years, and retrospectively analyzed their CT scans. Medical records were reviewed for demographics, management, surgical pathology diagnosis, and outcome. We compared CT findings between SMAT and SMVT groups. Multivariate analysis was conducted to determine the independent CT findings of life-threatening mesenteric occlusion. RESULTS: Of 43 patients, 24 had life-threatening mesenteric occlusion. Death related to mesenteric occlusion was 32.6%. A thick bowel wall (p < 0.001), mesenteric edema (p < 0.001), and ascites (p = 0.009) were more frequently associated with SMVT, whereas diminished bowel enhancement (p = 0.003) and paralytic ileus (p = 0.039) were more frequent in SMAT. Diminished bowel enhancement (OR = 20; p = 0.007) and paralytic ileus (OR = 16; p = 0.033) were independent findings suggesting life-threatening mesenteric occlusion. CONCLUSION: The ancillary CT findings occur with different frequencies in SMAT and SMVT. However, the independent findings indicating life-threatening mesenteric occlusion are diminished bowel wall enhancement and paralytic ileus.

Reconstruction of portal vein and superior mesenteric vein after extensive resection for pancreatic cancer / 대한외과학회지

PURPOSE: Tumor invasion to the portal vein (PV) or superior mesenteric vein (SMV) can be encountered during the surgery for pancreatic cancer. Venous reconstruction is required, but the optimal surgical methods and conduits remain in controversies. METHODS: From January 2007 to July 2012, 16 venous reconstructions were performed during surgery for pancreatic cancer in 14 patients. We analyzed the methods, conduits, graft patency, and patient survival. RESULTS: The involved veins were 14 SMVs and 2 PVs. The operative methods included resection and end-to-end anastomosis in 7 patients, wedge resection with venoplasty in 2 patients, bovine patch repair in 3 patients, and interposition graft with bovine patch in 1 patient. In one patient with a failed interposition graft with great saphenous vein (GSV), the SMV was reconstructed with a prosthetic interposition graft, which was revised with a spiral graft of GSV. Vascular morbidity occurred in 4 cases; occlusion of an interposition graft with GSV or polytetrafluoroethylene, segmental thrombosis and stenosis of the SMV after end-to-end anastomosis. Patency was maintained in patients with bovine patch angioplasty and spiral vein grafts. With mean follow-up of 9.8 months, the 6- and 12-month death-censored graft survival rates were both 81.3%. CONCLUSION: Many of the involved vein segments were repaired primarily. When tension-free anastomosis is impossible, the spiral grafts with GSV or bovine patch grafts are good options to overcome the size mismatch between autologous vein graft and portomesenteric veins. Further follow-up of these patients is needed to demonstrate long-term patency.

Efficacy of thrombolytic therapy on superior mesenteric vein thrombosis by percutaneous transhepatic portal vein catheterization / 中国综合临床

Objective To evaluate the therapeutic efficacy of percutaneous transhepatic portal vein catheterization and thrombolysis on superior mesenteric vein thrombosis.Methods The treatment and therapeutic efficacy of 15 cases of patients with superior mesenteric vein thrombosis underwent percutaneous transhepatic portal vein catheterization and thrombolysis from January 2000 to April 2011 were retrospectively analyzed.Results Percutaneous transhepatic portal vein catheterization was performed successfully in 15patients,without pneumothorax,bile leakage and intra-abdominal hemorrhage after catheterization.Eleven patients had good thrombolytic effect,with majority or complete recanalization on superior mesenteric vein,portal vein and splenic vein.The rate of recanalization Was 73.3％,total mortality was 13.3％.The total amount of urokinase was not more than 500 million U,and there was no cases with systemic bleeding.From 6 months to 36months follow-up,there was no increased portal vein system thrombosis and recurrent cases.Conclnsion Thrombolysis technique of percutaneous transhepatic portal vein catheterization is easy to master,and with good effect of local infusion thrombolytic therapy and lower complication rate.It's a selectable treatment for superior mesenteric vein thrombosis.