Komori Shuji, Kawai Masahiko, Nitta Toyoo, Murase Yusuke, Matsumoto Keita, Shinoda Chika, Kuno Masashi, Sasaguri Yuki, Fukada Masahiro, Asano Yoshimi, Kiyama Shigeru, Tanaka Chihiro, Nagao Yasuko, Nagao Narutoshi, Kunieda Katsuyuki
Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500-8717, Japan.
World J Surg Oncol. 2016 Feb 24;14(1):47. doi: 10.1186/s12957-016-0806-8.
Carcinoma and adenoma of the duodenum, including the papilla of Vater, are problematic diseases in patients with familial adenomatous polyposis (FAP).
A 36-year-old man underwent a periodic medical examination for early colon cancer originating from FAP for which laparoscopic-assisted subtotal colectomy with a J-shaped ileal pouch-rectal anastomosis was performed 3 years earlier. A tumor was detected at the papilla of Vater along with elevation of total bilirubin and hepatobiliary enzymes. Although cytology did not determine the tumor to be an adenocarcinoma, we suspected adenocarcinoma due to its hypervascularity shown by contrast-enhanced computed tomography. Pylorus-preserving pancreaticoduodenectomy with modified Imanaga reconstruction and regional lymph node dissection (D2) was performed. The pathological study showed that the tumor was a papillary and moderately differentiated tubular adenocarcinoma. The patient is currently in good health without recurrence, weight loss, or severe diarrhea at 12 months after surgery.
Awareness of biliary-pancreatic symptoms and periodic gastroduodenoscopy might contribute both to the early detection of duodenal or periampullary polyps and cancer and to the radical treatment of FAP. Modified Imanaga reconstruction has the potential to become one of the more effective procedures for providing good quality of life to FAP patients with duodenal or periampullary cancer.
十二指肠癌和腺瘤，包括 Vater 乳头癌，是家族性腺瘤性息肉病（FAP）患者中的疑难病症。
一名 36 岁男性因 FAP 引发的早期结肠癌接受定期体检，3 年前接受了腹腔镜辅助下全结肠次全切除术及 J 形回肠袋 - 直肠吻合术。在 Vater 乳头处发现一个肿瘤，同时总胆红素和肝胆酶升高。尽管细胞学检查未确定肿瘤为腺癌，但由于增强计算机断层扫描显示其血管丰富，我们怀疑为腺癌。实施了保留幽门的胰十二指肠切除术、改良 Imanaga 重建术及区域淋巴结清扫术（D2）。病理研究表明该肿瘤为乳头状、中分化管状腺癌。术后 12 个月，患者目前健康状况良好，无复发、体重减轻或严重腹泻。
对胆胰症状的认识和定期进行胃十二指肠镜检查可能有助于早期发现十二指肠或壶腹周围息肉及癌症，并有助于 FAP 的根治性治疗。改良 Imanaga 重建术有可能成为为患有十二指肠或壶腹周围癌的 FAP 患者提供良好生活质量的更有效手术方法之一。
