Komagome Masahiko, Maki Akira, Kogure Ryota, Mitsui Tetsuya, Nagata Rihito, Miyata Yoichi, Ninomiya Riki, Beck Yoshifumi
Dept. of Hepatobiliary-Pancreatic Surgery, Saitama Medical Center, Saitama Medical University.
Gan To Kagaku Ryoho. 2019 Apr;46(4):817-819.
A 46-year-old woman with epigastric pain was found to have a tumor of the pancreatic head. Computed tomography(CT) revealed a plethoric and poorly-marginated, 7 cm tumor in the pancreatic head. The superior mesenteric vein(SMV)was infiltrated from the duodenal inferior margin and a 6 cm occlusion extended to the merger with the splenic vein. Diagnostic criteria identified locally advanced pancreatic cancer(UR-P)with a limitation in portal reconstruction. Endoscopic ultrasoundguided fine needle aspiration(EUS-FNA)diagnosed mixed acinar-endocrine carcinoma(MAEC). Due to rarity, a chemotherapy protocol has not been established. Thus, the first option for treatment was resection. CT showed that the required graft was 7 cm in length, with SMV 0.5 cm in diameter at the intestinal side and 1.4 cm in diameter at the hepatic side; accordingly, the superficial femoral vein (SFV)was selected for use. Compared to the external iliac vein, the graft is slightly thinner and about 10 cm can be harvested. This graft is useful for cases that require reconstruction of the distal SMV.
一名46岁上腹部疼痛的女性被发现患有胰头肿瘤。计算机断层扫描（CT）显示胰头有一个充血且边界不清的7厘米肿瘤。肠系膜上静脉（SMV）从十二指肠下缘受侵，6厘米的闭塞延伸至与脾静脉汇合处。诊断标准确定为局部进展期胰腺癌（UR-P），门静脉重建受限。内镜超声引导下细针穿刺活检（EUS-FNA）诊断为混合性腺泡-内分泌癌（MAEC）。由于该病罕见，尚未确立化疗方案。因此，首要治疗选择是手术切除。CT显示所需移植物长度为7厘米，SMV在肠侧直径为0.5厘米，在肝侧直径为1.4厘米；因此，选择股浅静脉（SFV）使用。与髂外静脉相比，该移植物稍细，可获取约10厘米。此移植物适用于需要重建远端SMV的病例。
