Harao Michiko, Hishinuma Shoichi, Tomihawa Morihiro, Baba Hideo, Ogata Yoshiro
Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1549-51.
Total pancreatectomy has been used to treat both benign and malignant diseases of the pancreas. The procedure of total pancreatectomy for invasive pancreatic cancer usually includes distal gastrectomy and splenectomy to prevent ischemic changes due to decreased blood supply. In this report, it was introduced a new technique of total pancreatectomy for invasive pancreatic cancer preserving both the whole stomach and spleen. The patient was a 61 year old man. Preoperative computed tomography (CT) showed a mass of tumor, measuring 23x18x25mm, located in the pancreatic head. It was tried, initially to perform pylorus-preserving pancreatoduodenectomy (PPPD). Repeated frozen section examination of the pancreatic stumps, however, revealed persistent cancer infiltration to the distal pancreas. Therefore, we altered the planned PPPD to total pancreatectomy preserving the whole stomach and spleen with severing both the splenic artery and vein at their origins. The postoperative course was uneventful. Enhanced CT following surgery showed sufficient blood supply to the whole stomach and spleen without any congestive changes of blood flow. This method is considered safe and useful for patients with both benign and malignant disease of the pancreas.
全胰切除术已被用于治疗胰腺的良性和恶性疾病。侵袭性胰腺癌的全胰切除手术通常包括远端胃切除术和脾切除术，以防止因血液供应减少而导致的缺血性改变。在本报告中，介绍了一种针对侵袭性胰腺癌的全胰切除新技术，该技术可保留整个胃和脾脏。患者为一名61岁男性。术前计算机断层扫描（CT）显示胰头有一个大小为23×18×25mm的肿瘤肿块。最初尝试进行保留幽门的胰十二指肠切除术（PPPD）。然而，对胰腺残端进行多次冰冻切片检查发现，远端胰腺存在持续性癌浸润。因此，我们将计划中的PPPD改为全胰切除术，保留整个胃和脾脏，并在脾动静脉的起始处将其切断。术后过程顺利。术后增强CT显示整个胃和脾脏有充足的血液供应，且无任何血流充血性改变。该方法被认为对患有胰腺良性和恶性疾病的患者安全且有用。
