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在胰腺手术期间门静脉重建后的血栓形成和抗凝:系统性审查
Max Heckler1, Georgios Polychronidis2, Benedict Kinny-Köster1
1Department of General, Visceral, and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany.
概括
胰腺癌的门静脉 (PV) 切除和重建可能导致血栓形成. 异构移植显示出更高的血栓形成率,而自身移植更安全. 标准的抗凝血策略尚未建立.
科学领域:
- 血管外科 血管外科
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 门静脉切除和重建对于治疗晚期胰腺癌至关重要.
- 重建PV的血栓形成是致病率和死亡率的重要原因.
- 目前的抗凝血方案缺乏标准化.
研究的目的:
- 在胰腺手术中评估PV重建后的早期和晚期血栓形成率.
- 根据PV重建技术和抗凝血疗法,比较血栓形成率.
- 评估血栓事件的临床影响.
主要方法:
- 按照PRISMA指南进行系统审查.
- 包括报告PV切除/重建和血栓形成数据的研究.
- 评估患者数量,重建类型,随访,死亡率,血栓形成率,血液损失和抗凝药.
主要成果:
- 对23项涉及2751名患者的研究进行了分析.
- 总体血栓形成率为15%; 静脉修复/贴片和端到端修复为12%.
- 异构移植的血栓形成率最高 (55%),其次是合成导管 (27%) 和自身移植 (10%).
- 早期血栓形成率:5% (静脉流动/贴片,端到端),7% (自身),15% (合成),22% (异质).
- 早期PV血栓形成与高达26%的死亡率相关.
结论:
- 在PV切除后的整体血栓形成率很低,但重建技术很重要.
- 异构插入移植带有最大的血栓形成风险.
- 目前的文献中没有明确的抗凝策略得到支持.
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