Minagawa Masaaki, Ichida Hirofumi, Yoshioka Ryuji, Gyoda Yu, Mizuno Tomoya, Imamura Hiroshi, Mise Yoshihiro, Yoshimatsu Hidehiko, Fukumura Yuki, Kato Kota, Kajiyama Yoshiaki, Saiura Akio
Department of Hepatobiliary-Pancreatic Surgery, Juntendo University, Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Surg Case Rep. 2020 Oct 8;6(1):267. doi: 10.1186/s40792-020-01019-0.
Pancreaticoduodenectomy after esophageal resection is technically difficult, because blood flow of the gastric conduit should be preserved. Celiac axis stenosis (CAS) is also a problem for pancreaticoduodenectomy, because arterial blood supply for the liver comes mainly through the collateral route from the superior mesenteric artery (SMA) via the gastroduodenal artery (GDA). Herein, we report the case of a patient with pancreatic head cancer who underwent a pancreaticoduodenectomy after esophagectomy with concomitant CAS.
A 76-year-old man with pancreatic head cancer was referred to our department. He had a history of esophagectomy with retrosternal gastric conduit reconstruction for esophageal cancer. Computed tomography showed severe CAS and a dilated collateral route between the SMA and the splenic artery (SPA). We prepared several surgical options depending on the intraoperative findings, and performed radical pancreaticoduodenectomy with concomitant resection of the distal gastric conduit. The right gastroepiploic artery (RGEA) of the remnant gastric conduit was fed from the left middle colic artery (MCA) with microvascular anastomosis. Despite CAS, when the GDA was dissected and clamped, good blood flow was confirmed, and the proper hepatic artery did not require reconstruction. The patient was discharged on postoperative day 90.
We successfully performed radical pancreaticoduodenectomy after esophagectomy with concomitant CAS, having prepared multiple surgical options depending upon the intraoperative findings.
食管切除术后行胰十二指肠切除术在技术上具有挑战性，因为需要保留胃代食管的血供。腹腔干狭窄（CAS）也是胰十二指肠切除术面临的一个问题，因为肝脏的动脉血供主要通过肠系膜上动脉（SMA）经胃十二指肠动脉（GDA）的侧支循环途径提供。在此，我们报告一例胰头癌患者在食管切除术后合并CAS的情况下接受胰十二指肠切除术的病例。
一名76岁的胰头癌男性患者转诊至我科。他有因食管癌行食管切除并经胸骨后胃代食管重建术的病史。计算机断层扫描显示严重的CAS以及SMA与脾动脉（SPA）之间扩张的侧支循环途径。我们根据术中发现准备了多种手术方案，并在切除远端胃代食管的同时进行了根治性胰十二指肠切除术。残余胃代食管的胃网膜右动脉（RGEA）通过微血管吻合由左结肠中动脉（MCA）供血。尽管存在CAS，但在解剖并夹闭GDA时，确认血流良好，且肝固有动脉无需重建。患者术后第90天出院。
我们成功地在食管切除术后合并CAS的情况下进行了根治性胰十二指肠切除术，根据术中发现准备了多种手术方案。
