Tomimaru Yoshito, Ishikawa Osamu, Ohigashi Hiroaki, Eguchi Hidetoshi, Yamada Terumasa, Sasaki Yo, Miyashiro Isao, Ohue Masayuki, Yano Masahiko, Uehara Hiroyuki, Nakaizumi Akihiko, Imaoka Shingi
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Japan.
J Surg Oncol. 2006 May 1;93(6):511-5. doi: 10.1002/jso.20387.
Recently there has been an increase in the number of case reports detailing the recurrence of cancer in the pancreatic remnants following surgical resection of intraductal papillary mucinous carcinoma (IPMC) of the pancreas. A case is presented here to indicate the advantage of pancreaticogastrostomy (PG) in terms of postoperative follow-up after pancreaticoduodenectomy (PD) for IPMC. A 68-year-old man underwent PD for IPMC of the pancreatic head, and the cut margin of the pancreatic duct was diagnosed as having no cancer but moderately dysplastic epithelium by an intraoperative frozen section of histology. Thus, we decided to proceed with a PG rather than pancreaticojejunostomy (PJ) in order to facilitate easier postoperative examinations. Eight years and 6 months later, during a routine follow-up examination, duct dilation of the remnant pancreas was detected by magnetic resonance imaging (MRI). Upon examination by endoscopic gastroscopy, the anastomotic site was found to be covered with a large amount of mucin from which we easily obtained both cytologic and biopsied specimens, which subsequently proved positive for cancer. In line with our diagnosis of recurrent IPMC, the patient underwent a second surgery (resection of the remnant pancreas, total pancreatectomy) and postoperative histology confirmed that indeed the patient had experienced recurrent IPMC with no nodal involvement or invasion beyond the pancreatic confines. Based on this experience, we decided to recommend PG for all patients deemed to be at high risk for the recurrence of cancer in the pancreatic remnants following PD for IPMC of the pancreatic head.
最近，详细描述胰腺导管内乳头状黏液性癌（IPMC）手术切除后胰腺残端癌症复发的病例报告数量有所增加。本文介绍了一例病例，以说明胰胃吻合术（PG）在胰头IPMC胰十二指肠切除术（PD）术后随访方面的优势。一名68岁男性因胰头IPMC接受了PD手术，术中胰腺导管切缘经组织学冰冻切片诊断为无癌，但上皮中度发育异常。因此，为了便于术后检查，我们决定进行PG而非胰空肠吻合术（PJ）。八年零六个月后，在一次常规随访检查中，通过磁共振成像（MRI）检测到残余胰腺的导管扩张。经内镜胃镜检查，发现吻合部位覆盖有大量黏液，我们很容易从中获取了细胞学和活检标本，随后证实为癌症阳性。根据我们对复发性IPMC的诊断，患者接受了第二次手术（切除残余胰腺、全胰切除术），术后组织学证实患者确实患有复发性IPMC，无淋巴结受累，且未侵犯胰腺范围以外。基于这一经验，我们决定建议所有被认为在胰头IPMC行PD术后胰腺残端癌症复发风险较高的患者采用PG。
