Jang Ji Young, Chung Young Eun, Kang Chang Moo, Choi Sung Hoon, Hwang Ho Kyoung, Lee Woo Jung
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2012 Jul;60(1):52-5. doi: 10.4166/kjg.2012.60.1.52.
Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery.
门静脉环周胰腺是胰腺融合异常之一，其中胰腺钩突通过环绕门静脉或肠系膜上静脉延伸与背侧胰腺融合。我们报告了连续两例门静脉环周胰腺患者。第一例是一名71岁男性患者，因胰头导管内乳头状黏液性肿瘤接受了胰十二指肠切除术。他术前的计算机断层扫描显示为脾上型门静脉环周胰腺。第二例是一名74岁女性患者，因胰体癌接受了腹腔镜前入路顺行模块化胰脾切除术（RAMPS）。术中发现，两例患者的门静脉汇合处（肠系膜上静脉-脾静脉-门静脉）均被胰腺钩突包绕。因此，他们都需要在胰腺颈部进行两次胰腺分割。术后分别发生了B级和A级术后胰瘘，经保守治疗得到控制。外科医生在进行手术干预之前需要了解这种罕见的胰腺疾病，以避免并发症，并为患者提供精心设计的、针对具体病例的胰腺手术。
