中国实用外科杂志2025，Vol.45Issue(3)：274-278,5.DOI:10.19538/j.cjps.issn1005-2208.2025.03.07
合并腹腔干狭窄者行胰十二指肠切除术围手术期风险评估与多学科干预策略
Perioperative risk assessment and multidisciplinary intervention strategies for pancreaticoduodenectomy in patients with celiac axis stenosis
摘要
Abstract
Celiac axis stenosis(CAS)is one of the risk factors for severe complications following pancreaticoduodenectomy(PD).CAS is significantly associated with complications such as pancreatic fistula,bile leakage,hepatic ischemia,and delayed gastric emptying,and may increase perioperative mortality.The diagnosis of CAS primarily relies on CT,MRI or angiography,with a stenosis＞50％confirming the diagnosis.Its etiology is categorized into extraluminal compression(e.g.,median arcuate ligament compression)and intraluminal lesions(e.g.,atherosclerotic plaques).As the aging population increases,the proportion of CAS related to atherosclerosis has significantly risen.Notably,CAS is often coexistent with superior mesenteric artery(SMA)stenosis,where collateral circulation relies on the blood vessels in the pancreatic head region(e.g.,gastroduodenal artery,GDA)to maintain blood supply to the celiac artery.During PD,transection of the GDA disrupts the collateral circulation,leading to ischemia of the liver,spleen,and remnant pancreas,thereby causing severe complications.Management strategies for CAS should be individualized.Preoperative imaging evaluation should focus on signs of narrowing at the celiac artery origin and abnormal vasculature in the pancreatic head region.For CAS caused by arterial plaques,endovascular stent placement or balloon dilation may be considered;for median arcuate ligament compression,ligament release surgery should be performed intraoperatively.If CAS is discovered intraoperatively,the GDA may be preserved or vascular reconstruction(such as celiac artery reimplantation)may be performed.For cases where the GDA cannot be preserved,postoperative vigilance for liver,spleen,and remnant pancreas is crucial,with timely vascular intervention if needed.Although some cases have been reported to recover without intervention,multivariate analysis indicates that severe CAS is an independent risk factor for postoperative hepatic hypoperfusion and pancreatic fistula.With the increasing proportion of elderly individuals in China,the number of pancreatic disease patients concomitant with CAS is expected to rise.Pancreatic surgeons should strengthen preoperative imaging assessments,identify CAS early,and develop intervention strategies to reduce the risk of postoperative complications.Multidisciplinary collaboration and the establishment of standardized treatment protocols are crucial directions for optimizing outcomes in these patients in the future.关键词
腹腔干狭窄/胰十二指肠切除术/正中弓状韧带压迫/动脉粥样硬化/术后并发症Key words
celiac axis stenosis/pancreaticoduodenectomy/median arcuate ligament compression/atherosclerosis/postoperative complications分类
医药卫生引用本文复制引用
卫积书..合并腹腔干狭窄者行胰十二指肠切除术围手术期风险评估与多学科干预策略[J].中国实用外科杂志,2025,45(3):274-278,5.基金项目
国家自然科学基金项目(No.81972323) National Natural Science Foundation of China(No.81972323) （No.81972323）
