Clinical value of semi-ex vivo intestinal autotransplantation for patients with mesenteric root regional tumors accompanied by vascular invasion
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摘要:目的
探讨半离体自体小肠移植(IATx)用于肠系膜根部区域肿瘤伴血管侵犯患者的临床价值。
方法采用回顾性描述性研究方法。收集2021年9月至2022年12月四川省医学科学院·四川省人民医院收治的6例行半离体IATx患者的临床病理资料;男4例,女2例;年龄为(47±21)岁。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。正态分布的计量资料以x±s表示。计数资料以绝对数表示。
结果(1)手术情况。6例患者顺利完成半离体IATx。6例患者手术时间为(10.2±2.1)h、热缺血时间为(2.3±1.6)min、冷缺血时间为(49.2±15.6)min、术中输血量为(707±263)mL。6例患者中, 3例术中行冷冻威斯康星大学保存液(UW液)灌注,3例术中未行UW液灌注。(2)术后情况。6例患者术后病理学检查结果显示:4例为胰腺导管腺癌,1例为胆管腺癌,1例为肠系膜纤维瘤病。6例患者手术切缘均为阴性,术后住院时间为(19±4)d。6例患者术后均未出现胃肠道出血及吻合口瘘,自体移植肠道功能良好。6例患者围手术期无死亡,出院后无需静脉补液。(3)随访情况。6例患者均获得随访,随访时间为(12±5)个月。6例患者中,仅1例肠系膜纤维瘤病患者术后第7个月复发,其余 5例患者无复发、转移。6例患者中,4例出现慢性腹泻,口服罗哌丁胺、双歧杆菌及胰酶胶囊后症状缓解。6例患者均生存。
结论半离体IATx用于治疗肠系膜根部区域肿瘤伴血管侵犯患者安全、可行,近期疗效良好。
Abstract:ObjectiveTo explore the clinical value of semi-ex vivo intestinal autotrans-plantation (IATx) for patients with mesenteric root regional tumors accompanied by vascular invasion.
MethodsThe retrospective and descriptive study was conducted. The clinicopathological data of 6 patients who underwent semi-ex vivo IATx in the Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital from September 2021 to December 2022 were collected. There were 4 males and 2 females, aged (47±21)years. Observation indicators: (1) surgical conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were represented by Mean±SD. Count data were represented by absolute numbers.
Results(1) Surgical conditions. All 6 patients completed semi-ex vivo IATx successfully. The operation time, warm ischemia time, cold ischemia time, volume of intraoperative blood transfusion were (10.2±2.1)hours, (2.3±1.6)minutes, (49.2±15.6)minutes, (707±263)mL. Of the 6 patients, 3 patients were intraoperatively perfused with cold UW solution, while the other 3 were not. (2) Postoperative conditions. Results of postoperative pathological examination of the 6 patients showed 4 cases of pancreatic ductal adenocarcinoma, 1 case of cholangiocarcinoma, and 1 case of mesenteric fibromatosis. All 6 cases had nega-tive surgical margins and the duration of postoperative hospital stay was (19±4)days. None of the patient had gastrointestinal bleeding or anastomotic leakage postoperatively, and the autotransplanted intestine functioned well. There was no perioperative death, and intravenous rehydration was not required after discharge. (3) Follow-up. All 6 patients were followed up for (12±5)months. Only 1 patient with mesenteric fibromatosis had recurrence in the 7th month postoperatively, while the remaining 5 patients showed no sign of recurrence or metastasis. There were 4 of 6 patients with chronic diarrhea. They were improved after oral loperamide, bifidobacterium and pancreatin capsules. All 6 patients survived.
ConclusionSemi-ex vivo IATx for the treatment of patients with mesenteric root regional tumors accompanied by vascular invasion is safe and feasible, which can achieve good short-term efficacy.
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Keywords:
- Intestinal autotransplantation /
- Abdominal neoplasms /
- Revascularization /
- Treatment /
- Surgery /
- Efficacy
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游欣雨、庞北川:文稿的撰写,数据统计分析及参与手术实施;程东辉、左邦佑、蒋佶朋、郝建杰、刘涛:文稿修订与手术实施,基础数据的收集;张宇:手术方案制订与实施,文稿的修订与困难问题的指导,提供基金支持所有作者均声明不存在利益冲突游欣雨, 庞北川, 程东辉, 等. 半离体自体小肠移植用于肠系膜根部区域肿瘤伴血管侵犯患者的临床价值[J]. 中华消化外科杂志, 2023, 22(11): 1361-1366. DOI: 10.3760/cma.j.cn115610-20230914-00095.
http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cn115610-20230914-23095
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图 1 半离体自体小肠移植患者术前影像学检查 1A:增强CT(横断位)检查结果示肠系膜根部肿瘤包绕肠系膜上动脉主干>180°(➝);1B:增强CT(冠状位)检查结果示肿瘤包绕肠系膜上动脉(➝)及空肠动脉(←);1C:血管三维重建显示肿瘤侵犯包绕肠系膜上动脉及空肠动脉(白色虚线示受侵犯空肠动脉)
Figure 1. Preoperative radiological examination for patients undergoing semi⁃ex vivo intestinal autotransplantation 1A: Axial enhanced computed tomography (CT) scan showed the tumor at mesenteric root encircling the main trunk of superior mesenteric artery >180° (➝); 1B: Coronal enhanced CT scan showed the tumor encircling the main trunk of superior mesenteric artery (➝) and jejunal artery (←); 1C: Three⁃dimensional vascular recons⁃truction showed tumor invasion encircling the superior mesenteric artery and jejunal artery (white dashed line indicating the involved jejunal artery)
图 2 半离体自体小肠移植手术过程 2A:骨骼化、悬吊肠系膜上静脉、肠系膜上动脉;2B:半离体灌注;2C:空肠动脉‑肠系膜上动脉端侧吻合;2D:吻合肠系膜上动脉;2E:吻合肠系膜上静脉;2F:采用吲哚菁绿荧光融合影像检查患者重建后肠系膜上动、静脉及小肠血供情况
Figure 2. The procedure of semi⁃ex vivo intestinal autotransplantation 2A: Skeletonization and ligation of superior mesenteric vein and superior mesenteric artery; 2B: Semi⁃ex vivo infusion; 2C: End⁃to⁃side anastomosis between the jejunal artery and the superior mesenteric artery; 2D: Anastomosis of the superior mesenteric artery; 2E: Anastomosis of the superior mesenteric vein; 2F: Fusion indocyanine green fluorescence imaging was conducted to assess the blood supply of the reconstructed superior mesenteric artery, vein and small intestine
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