Sato Shunsuke, Miyazawa Kotaro, Shiobara Masayuki, Wakatsuki Kazuo, Ogasawara Takeshi, Suda Kosuke, Aida Toshiaki, Miyoshi Tetsutaro, Yoshioka Sigeru, Yamazaki Kazuhito
Dept. of Surgery, Chiba Kaihin Municipal Hospital.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2521-2523.
Intraductal papillary mucinous neoplasm(IPMN)of the pancreas often presents with multifocal lesions. Complete resection without residual skip lesions is essential for complete eradication of the disease. We experienced a case of IPMC in which intraoperative pancreatoscopy was used to determine the surgical margin. Intraoperative pancreatoscopy is a useful and easy method to evaluate the remnant duct and exclude residual tumor. A cystic lesion was incidentally detected in the pancreatic head of a 78-year-old man. Ultrasonography, abdominal computed tomography, magnetic resonance imaging, and endoscopic ultrasound revealed enhancing mural nodules in the pancreatic head and dilation of the entire main pancreatic duct. We performed pancreaticoduodenectomy for mixed IPMN. Intraoperative pancreatoscopy, which was performed to rule out skip lesions, showed no mucosal abnormalities in the remnant duct. The pathological diagnosis was non-invasive intraductal papillary-mucinous carcinoma(IPMC). No signs of recurrence were seen for 6 postoperative months.
胰腺导管内乳头状黏液性肿瘤（IPMN）常表现为多灶性病变。无残留跳跃性病变的完整切除对于彻底根除该疾病至关重要。我们遇到一例IPMC病例，术中使用胰管镜来确定手术切缘。术中胰管镜是一种评估残余胰管并排除残留肿瘤的有用且简便的方法。一名78岁男性的胰头部偶然发现一个囊性病变。超声、腹部计算机断层扫描、磁共振成像和内镜超声显示胰头部有强化的壁结节以及整个主胰管扩张。我们对混合型IPMN实施了胰十二指肠切除术。为排除跳跃性病变而进行的术中胰管镜检查显示残余胰管无黏膜异常。病理诊断为非侵袭性导管内乳头状黏液癌（IPMC）。术后6个月未见复发迹象。
