Kim Chiwan, Tono Takeshi, Kimura Yutaka, Watanabe Ami, Nakamura Hidetoshi, Inadome Jun-Ichi, Danno Katsuki, Kagara Naofumi, Taniguchi Hirokazu, Kanoh Toshiyuki, Ohnishi Tadashi, Nakano Yoshiaki, Monden Takushi, Imaoka Shingi
Dept. of Surgery, NTT West Osaka Hospital.
Gan To Kagaku Ryoho. 2011 Nov;38(12):2448-50.
A 70-year-old female suffered from jaundice was admitted to our hospital for a tumor in the pancreas head. CA19-9 and DUPAN-2 levels were increased in laboratory test. Enhanced abdominal computed tomography (CT) scan revealed a low density area of pancreas head. Cytology of pancreatic juice was performed by ERCP, and malignant cells were detected. Pancreaticoduodenectomy was performed under a diagnosis of pancreatic cancer (T3N1M0, stage III). Despite of adjuvant chemotherapy (gemcitabine) after surgery, CT scan revealed a low density area in the cut end of remnant pancreas at 3 months, which was accompanied with elevation of and CA19-9 and DUPAN-2 levels. We diagnosed as a recurrent pancreatic cancer of remnant pancreas without any other side of recurrence and re-resection was performed. Because of chylous ascites and depression following a second surgery, postoperative adjuvant chemotherapy could not be started. Re-recurrence was detected at 3 months after the second surgery, and she died 6 months after the surgery. Remnant or repeated pancreatectomy for local recurrent pancreatic carcinomas is extremely rare with limited number of cases reported in the literature. We report our experience, and discuss the significance of re-resection for recurrence of remnant pancreas.
一名70岁患有黄疸的女性因胰头肿瘤入住我院。实验室检查显示CA19-9和DUPAN-2水平升高。腹部增强计算机断层扫描（CT）显示胰头有低密度区。通过内镜逆行胰胆管造影（ERCP）对胰液进行细胞学检查，检测到恶性细胞。在胰腺癌（T3N1M0，III期）诊断下进行了胰十二指肠切除术。尽管术后进行了辅助化疗（吉西他滨），但术后3个月CT扫描显示残余胰腺切端有低密度区，同时伴有CA19-9和DUPAN-2水平升高。我们诊断为残余胰腺复发性胰腺癌，无其他复发部位，并进行了再次切除。由于二次手术后出现乳糜腹水和抑郁，术后辅助化疗未能开始。二次手术后3个月检测到再次复发，患者术后6个月死亡。文献报道中，针对局部复发性胰腺癌进行残余或重复胰腺切除术极为罕见，病例数量有限。我们报告我们的经验，并讨论残余胰腺复发再次切除的意义。
