Kimura Wataru, Fuse Akira, Hirai Ichiro, Suto Koichi, Suzuki Akihiko, Moriya Toshiyuki, Sakurai Fumiaki
Department of Organ Function and Controls, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata City, Yamagata 990-9585, Japan.
Hepatogastroenterology. 2003 Nov-Dec;50(54):2242-5.
Preservation of the spleen at distal pancreatectomy has recently attracted considerable attention. Since our first trial and success with spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for tumors of the pancreas and chronic pancreatitis, this procedure has been performed more frequently. Three patients with intraductal papillary-mucinous tumor underwent spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein. In this procedure, the splenic vein is identified behind the pancreas and the connective tissue membrane is cut longitudinally above the splenic vein. An important point is to remove the splenic vein from the pancreas from the body of the pancreas toward the spleen. In one patient with intraductal papillary-mucinous tumor in the body of the pancreas who had undergone distal gastrectomy for duodenal ulcer 32 years previously, residual proximal gastrectomy could be avoided with this procedure. In this case, the histological diagnosis was a pseudocyst, and epithelial dysplasia was found in other pancreatic ductuli. In another case, epithelia were borderline between hyperplasia and adenoma. In both of these cases, the histological diagnosis was different from the preoperative diagnosis. Even with advances in imaging techniques, diagnosis of a cystic lesion of the pancreas is still very difficult. Ordinary distal pancreatectomy with splenectomy would have been oversurgery in these two cases, which could be avoided using our procedure. Severe complications were not found in any of the three cases and the postoperative course was uneventful. The patients have been followed as outpatients without any recurrence. Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein is easy and safe, and should be performed for some patients with intraductal papillary mucinous tumor of the pancreas.
近期，在胰体尾切除术时保留脾脏受到了广泛关注。自从我们首次成功试行保留脾脏的胰体尾切除术，同时保留脾动静脉用于治疗胰腺肿瘤和慢性胰腺炎以来，此术式的开展愈发频繁。3例导管内乳头状黏液瘤患者接受了保留脾脏的胰体尾切除术，同时保留脾动静脉。在此手术中，在胰腺后方识别出脾静脉，并在脾静脉上方纵向切开结缔组织膜。关键在于从胰体向脾脏方向将脾静脉从胰腺上分离。1例胰体部导管内乳头状黏液瘤患者，32年前因十二指肠溃疡接受过远端胃切除术，采用此术式避免了残留近端胃切除术。在此病例中，组织学诊断为假性囊肿，在其他胰小管中发现上皮发育异常。在另一病例中，上皮处于增生与腺瘤之间的临界状态。这两例的组织学诊断均与术前诊断不同。即便影像技术有所进步，胰腺囊性病变的诊断依旧十分困难。在这两例中，普通的胰体尾切除加脾切除术属于过度治疗，而采用我们的术式则可避免。3例患者均未出现严重并发症，术后恢复顺利。患者作为门诊病人接受随访，无任何复发情况。保留脾脏的胰体尾切除术，同时保留脾动静脉，操作简便且安全，对于部分胰腺导管内乳头状黏液瘤患者应予以施行。
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