Sergeant Gregory, Schadde Erik, Maleux Geert, Aerts Raymond
Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium ; Swiss HPB Center, Department for Visceral and Transplantation Surgery, University Hospital Zurich, 8091 Zurich, Switzerland.
Case Rep Med. 2013;2013:205475. doi: 10.1155/2013/205475. Epub 2013 Aug 4.
A 64-year-old female patient with adenocarcinoma of the head of the pancreas with encasement of the common hepatic artery and portal vein stenosis was reexplored after six cycles of gemcitabine (1000 mg/m(2)). Prior to surgery, the patient underwent balloon dilation and stenting of the portal vein in addition to successful coil embolisation of the common hepatic artery, proper hepatic artery, and proximal gastroduodenal artery. After embolisation, a pylorus-preserving pancreaticoduodenectomy was performed with resection of the common hepatic artery and portal vein confluens. Pathological examination showed a moderately differentiated pT3N0 (Stage IIa, TNM 7th edition) tumor with negative section margins. We show with this case that in selected cases of periampullary cancer with encasement of the common hepatic artery, it is technically feasible to perform pancreaticoduodenectomy with hepatic artery resection and negative surgical margins. Nevertheless, the oncological benefit of extended arterial resections remains controversial.
一名64岁的女性患者，患有胰头腺癌，伴有肝总动脉包绕和门静脉狭窄，在接受六个周期的吉西他滨（1000mg/m²）治疗后进行了再次探查。手术前，除了成功对肝总动脉、肝固有动脉和胃十二指肠动脉近端进行弹簧圈栓塞外，患者还接受了门静脉球囊扩张和支架置入术。栓塞后，实施了保留幽门的胰十二指肠切除术，切除了肝总动脉和门静脉汇合处。病理检查显示为中度分化的pT3N0（IIa期，TNM第7版）肿瘤，切缘阴性。我们通过该病例表明，在某些肝总动脉被包绕的壶腹周围癌病例中，进行肝动脉切除且手术切缘阴性的胰十二指肠切除术在技术上是可行的。然而，扩大动脉切除的肿瘤学益处仍存在争议。
