Chiba Naokazu, Gunji Takahiro, Ozawa Yosuke, Hikita Kosuke, Sano Toru, Tomita Koichi, Abe Yuta, Kawachi Shigeyuki
Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Japan.
Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Japan.
Int J Surg Case Rep. 2017;41:209-211. doi: 10.1016/j.ijscr.2017.10.041. Epub 2017 Oct 27.
Surgical resection is the only curative treatment for perihilar cholangiocarcinoma. However, Hepatopancreatoduodenectomy (HPD) procedure remains controversial in regard to the balance between the survival benefit and high risk of mortality and morbidity.
A 72-year-old man who was revealed the dilation of intrahepatic hepatic duct by computed tomography after laparoscopic total gastrectomy was referred to our hospital. The patient had undergone laparoscopic total gastrectomy with Roux-en-Y esophageal-jejunostomy reconstruction 1year previously. By several examinations, we consequently diagnosed this case as a perihilar cholangiocarcinoma and performed HPD. Histological examination revealed a well differentiated adenocarcinoma without lymph-node metastasis and a negative margin of liver parenchyma and pancreas. He was recovered from a grade B pancreatic fistula by conservative therapy and discharged post-operatively on day 64 in good health. The patient received postoperative systemic chemotherapy with gemcitabine for 6 months. 16 months after surgery, the patient has had no recurrence.
HPD for biliary and cancers after total gastrectomy is a challenging procedure with high morbidity and mortality rates. However, this procedure can provide the chance for long-term survival if curative resection is feasible.
This case was the first report of hepatopancreatoduodenectomy following laparoscopic total gastrectomy.
手术切除是肝门部胆管癌唯一的治愈性治疗方法。然而，胰十二指肠切除术（HPD）在生存获益与高死亡率和发病率风险之间的平衡方面仍存在争议。
一名72岁男性，在腹腔镜全胃切除术后通过计算机断层扫描发现肝内胆管扩张，转诊至我院。该患者1年前接受了腹腔镜全胃切除术并进行了Roux-en-Y食管空肠吻合重建。通过多项检查，我们最终将该病例诊断为肝门部胆管癌并实施了胰十二指肠切除术。组织学检查显示为高分化腺癌，无淋巴结转移，肝实质和胰腺切缘阴性。经保守治疗，他从B级胰瘘中康复，术后第64天健康出院。患者接受了吉西他滨术后全身化疗6个月。术后16个月，患者无复发。
全胃切除术后行胰十二指肠切除术治疗胆管癌是一项具有挑战性的手术，发病率和死亡率较高。然而，如果可行根治性切除，该手术可提供长期生存的机会。
本病例是腹腔镜全胃切除术后行胰十二指肠切除术的首例报道。
