Mizutani Toru, Murayama Yasutoshi, Ikoma Hisashi, Arita Tomohiro, Kosuga Toshiyuki, Konishi Hirotaka, Morimura Ryo, Shiozaki Atsushi, Kuriu Yoshiaki, Nakanishi Masayoshi, Fujiwara Hitoshi, Okamoto Kazuma, Otsuji Eigo
Division of Digestive Surgery, Dept. of Surgery, Kyoto Prefectural University of Medicine.
Gan To Kagaku Ryoho. 2018 Mar;45(3):575-577.
Curative resection is necessary to survival in pancreatic cancer, however after surgery, pathologic examination sometimes diagnoses the remains of cancer at the resected stump. Therefore, it is necessary to evaluate the stump by intraoperative rapid pathological examination. 5-aminolevulinic acid(5-ALA)is an endogenous natural amino acid and precursor of the heme pathway. 5-ALA is metabolized and accumulated as protoporphyrin IX(Pp IX)that is photosensitive substance. 5-ALA mediated photodynamic diagnosis(PDD)(ALA-PDD)has high diagnostic ability. Andwe previously reportedusefulness of ALA-PDD for lymph node metastasis and peritoneal dissemination in gastric cancer and colorectal cancer patients. A case was 73-year-oldman who hadpancreatic headcancer. Since pancreatic cancer invasion to the inferior vena cava(IVC)was suspected during the operation, fluorescence observation was undergone. Pp IX fluorescence signal observedin the tissue around IVC by fluorescence observation. And, the tissue diagnosed adenocarcinoma by pathological findings. Therefore, it was judged that curative resection was difficult and the operation was completed. In conclusion, it was suggested that ALAPDD may be one of the methods of intraoperatively diagnosing the residual lesion of pancreatic cancer.
根治性切除对胰腺癌的生存至关重要，然而手术后，病理检查有时会在切除残端诊断出癌残留。因此，有必要通过术中快速病理检查评估残端。5-氨基乙酰丙酸（5-ALA）是一种内源性天然氨基酸，也是血红素途径的前体。5-ALA代谢并积累为原卟啉IX（Pp IX），这是一种光敏物质。5-ALA介导的光动力诊断（PDD）（ALA-PDD）具有较高的诊断能力。我们之前报道了ALA-PDD对胃癌和结直肠癌患者淋巴结转移和腹膜播散的有效性。有一例73岁男性患有胰头癌。由于术中怀疑胰腺癌侵犯下腔静脉（IVC），因此进行了荧光观察。通过荧光观察在IVC周围组织中观察到Pp IX荧光信号。并且，该组织经病理检查诊断为腺癌。因此，判断难以进行根治性切除，手术完成。总之，提示ALA-PDD可能是术中诊断胰腺癌残留病变的方法之一。
