Otsuka Shimpei, Sugiura Teiichi, Uesaka Katsuhiko
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
Surg Case Rep. 2016 Dec;2(1):126. doi: 10.1186/s40792-016-0255-1. Epub 2016 Nov 5.
Pancreas-sparing total duodenectomy (PSTD) is an ideal recommended procedure for patients with multiple duodenal adenomas or early duodenal cancer. We herein report a rare but serious complication of PSTD.
A 20-year-old woman with duodenal adenocarcinoma underwent PSTD. On postoperative day one, she complained of severe abdominal pains. Her serum amylase and serum pancreatic amylase levels were extremely elevated (Amy, 1296 IU/L; P-Amy, 1273 IU/L). With contrast enhanced CT, acute obstructive pancreatitis with pancreas divisum due to the ligation of the dorsal pancreatic duct was highly suspected. An emergency operation was performed to relieve the pancreatic duct obstruction, and an additional anastomosis between the dorsal pancreatic duct and jejunum was performed. The patient's postoperative course was mostly uneventful, and her discomfort improved immediately.
When we perform pancreas-sparing total duodenectomy, some form of pancreatography is necessary to exclude pancreas divisum.
保留胰腺的全十二指肠切除术（PSTD）是治疗多发性十二指肠腺瘤或早期十二指肠癌患者的理想推荐术式。我们在此报告一例PSTD罕见但严重的并发症。
一名20岁的十二指肠腺癌女性接受了PSTD。术后第一天，她主诉严重腹痛。她的血清淀粉酶和血清胰淀粉酶水平极度升高（淀粉酶，1296 IU/L；胰淀粉酶，1273 IU/L）。增强CT高度怀疑因结扎胰背侧导管导致胰腺分裂伴急性梗阻性胰腺炎。进行了急诊手术以解除胰管梗阻，并在胰背侧导管与空肠之间额外进行了吻合。患者术后病程大多平稳，不适症状立即改善。
当我们进行保留胰腺的全十二指肠切除术时，需要某种形式的胰管造影来排除胰腺分裂。
