Toshiyama Reishi, Yokoyama Shigekazu, Hashimoto Kazuhiko, Takeda Mitsunobu, Matsumoto Shinji, Fukuda Shuichi, Naito Atsushi, Tokuoka Masayoshi, Matsuyama Jin, Ide Yoshihito, Morimoto Takashi, Fukushima Yukio, Nomura Takashi, Kodama Ken, Shiba Ikue, Takeda Masashi, Sasaki Yo
Dept. of Surgery, Yao Municipal Hospital, Japan.
Gan To Kagaku Ryoho. 2012 Nov;39(12):2137-9.
Our patient was a 67-year-old man, with a chief complaint of brown urine. He subsequently underwent medical examination in June. Because the results of his blood examination revealed liver dysfunction, he was admitted to our hospital for further careful examination. An abdominal computed tomography(CT) scan showed the presence of a pancreas tumor, with a diameter of 2 cm, at the pancreas head, as well as common biliary duct dilatation and main pancreatic duct dilation from the head to the tail of the pancreas. The patient was diagnosed with pancreatic cancer[cT3( CH+, DU+), cN0, cM0, cStage III], with obstructive jaundice. After biliary drainage, we performed laparotomy in August. During the operation, other than the tumor on the pancreas head, identified at the preoperative diagnosis, we found 2 white nodules on the pancreas surface. One nodule was located at the body of the pancreas and the other, at its tail. On intraoperative pathological examination of the nodules, they were found to be invasive ductal carcinomas. On the basis of these findings, we suspected multiple cancers or overall pancreatic cancer; therefore, we performed total pancreatectomy, not pancreaticoduodenectomy (PD). We choose pancreatectomy over PD because it was impossible to confirm the cancerous area. Pathological examination of the resected specimen did not reveal any malignant lesion. Thus, if we had not performed pancreatectomy, assuming that the pancreas body or tail had no cancer lesion, based on the pathological examination result, the cancer would have persisted. Further, careful examination involving inspection and palpation is considered to be essential before resection of the pancreas tumor.
我们的患者是一名67岁男性，主要症状为尿液呈褐色。他随后于6月接受了医学检查。由于血液检查结果显示肝功能异常，他被收治入我院做进一步详细检查。腹部计算机断层扫描（CT）显示胰头有一个直径2厘米的胰腺肿瘤，同时伴有胆总管扩张以及从胰头至胰尾的主胰管扩张。该患者被诊断为胰腺癌[cT3(CH +, DU +), cN0, cM0, c分期III期]，伴有梗阻性黄疸。在进行胆道引流后，我们于8月进行了剖腹手术。手术过程中，除了术前诊断发现的胰头肿瘤外，我们还在胰腺表面发现了2个白色结节。一个结节位于胰体部，另一个位于胰尾部。对这些结节进行术中病理检查时，发现它们是浸润性导管癌。基于这些发现，我们怀疑存在多处癌症或整个胰腺都有癌变；因此，我们实施了全胰切除术，而非胰十二指肠切除术（PD）。我们选择全胰切除术而非胰十二指肠切除术是因为无法确定癌变区域。切除标本的病理检查未发现任何恶性病变。因此，如果我们没有进行全胰切除术，基于病理检查结果假设胰体或胰尾没有癌变，那么癌症将会持续存在。此外，在切除胰腺肿瘤之前，仔细的检查，包括视诊和触诊，被认为是必不可少的。
