Umemoto Kazufumi, Nakanishi Yoshitsugu, Murakawa Katsuhiko, Suzuki Tomohiro, Yamamura Yoshiyuki, Ono Koichi, Hirano Satoshi
Department of Surgery, Obihiro Kosei General Hospital, Obihiro, Japan.
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Asian J Endosc Surg. 2017 Nov;10(4):411-414. doi: 10.1111/ases.12391. Epub 2017 Jun 9.
Gastrointestinal stromal tumors of the duodenum are rare. For benign tumors, premalignant lesions, or malignant potential tumors located in the second portion of the duodenum close to the papilla of Vater, pancreaticoduodenectomy is sometimes performed. A case of laparoscopic segmental duodenectomy for a gastrointestinal stromal tumor at the second portion of the duodenum is reported. The surgical procedure was performed as follows: first, the second portion of the duodenum was separated from the pancreatic head; second, the duodenum was cut off with the linear stapler after having confirmed preservation of the papilla by intraoperative endoscopy; and third, reconstruction was carried out by a side-to-side duodenojejunostomy. Laparoscopic segmental duodenectomy for duodenal gastrointestinal stromal tumors is thought to be advantageous compared with pancreaticoduodenectomy in terms of low burden and organ function preservation. The present procedure is feasible for benign or low-malignant tumors that do not infiltrate outside of the duodenal walls.
十二指肠胃肠道间质瘤较为罕见。对于位于十二指肠第二部靠近十二指肠乳头的良性肿瘤、癌前病变或具有恶性潜能的肿瘤,有时会施行胰十二指肠切除术。本文报道了一例针对十二指肠第二部胃肠道间质瘤的腹腔镜节段性十二指肠切除术。手术步骤如下:首先,将十二指肠第二部与胰头分离;其次,在通过术中内镜确认乳头得以保留后,使用直线切割吻合器切断十二指肠;最后,通过十二指肠空肠侧侧吻合术进行重建。与胰十二指肠切除术相比,腹腔镜节段性十二指肠切除术被认为在减轻负担和保留器官功能方面具有优势。本手术对于未浸润至十二指肠壁外的良性或低恶性肿瘤是可行的。