Yamada Mihoko, Sugiura Teiichi, Okamura Yukiyasu, Ito Takaaki, Yamamoto Yusuke, Ashida Ryo, Uesaka Katsuhiko
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Shizuoka, Japan.
Surg Case Rep. 2017 Dec;3(1):28. doi: 10.1186/s40792-017-0306-2. Epub 2017 Feb 14.
Total pancreatectomy has occasionally been performed to treat patients with multiple lesions (such as intraductal papillary mucinous neoplasm (IPMN)) or patients who have undergone repeated pancreatic resection. However, deficiencies of the exocrine and endocrine functions worsen patients' quality of life. Recently, there have been several case reports citing middle segment-preserving pancreatectomy (MSPP) as a safe procedure and beneficial with respect to preservation of the exocrine and endocrine functions. We herein report the case of a patient who underwent MSPP for repeat pancreatectomy for IPMN and in whom a favorable outcome was achieved. The patient, a 70-year-old man, was diagnosed with branch duct-type IPMN (BD-IPMN) with worrisome features in the pancreatic head and a single cyst in the pancreatic tail, during a preoperative examination of early gastric cancer. Pancreatoduodenectomy was performed for BD-IPMN in the pancreatic head and gastric cancer. A histopathological examination showed an intraductal papillary mucinous adenoma (IPMA) with mild-moderate atypia. During the follow-up, the size of the cystic lesion in the pancreatic tail and the diameter of the main pancreatic duct were gradually increasing. Therefore, at 2 years and 6 months after surgery, distal pancreatectomy with preservation of the spleen (namely MSPP) was performed. The pancreatic resection margin was histologically negative. The length and volume of the remnant pancreas were approximately 6 cm and 10 ml, respectively. A histopathological examination showed an IPMA. The patient had no diarrhea or weight loss without digestive enzymes and maintained favorable glucose tolerance without oral hypoglycemic agents or insulin. He has showed no evidence of new lesions in the remnant pancreas at 3 years of follow-up after the last surgery.
全胰切除术偶尔用于治疗患有多个病灶（如导管内乳头状黏液性肿瘤（IPMN））的患者或接受过多次胰腺切除术的患者。然而，外分泌和内分泌功能的缺陷会恶化患者的生活质量。最近，有几例病例报告称，保留中段胰腺切除术（MSPP）是一种安全的手术，在保留外分泌和内分泌功能方面有益。我们在此报告一例因IPMN接受重复胰腺切除术而行MSPP且取得良好效果的患者。该患者为一名70岁男性，在早期胃癌术前检查时被诊断为胰头部具有可疑特征的分支导管型IPMN（BD-IPMN）和胰尾部单个囊肿。对胰头部的BD-IPMN和胃癌实施了胰十二指肠切除术。组织病理学检查显示为轻度至中度异型性的导管内乳头状黏液性腺瘤（IPMA）。随访期间，胰尾部囊性病变的大小和主胰管直径逐渐增大。因此，在术后2年6个月时，实施了保留脾脏的远端胰腺切除术（即MSPP）。胰腺切除切缘在组织学上为阴性。残余胰腺的长度和体积分别约为6 cm和10 ml。组织病理学检查显示为IPMA。该患者在未使用消化酶的情况下无腹泻或体重减轻，且在未使用口服降糖药或胰岛素的情况下维持良好的糖耐量。在上次手术后3年的随访中，他的残余胰腺未发现新病灶迹象。
