Department of Hepatobiliary and Pancreatic Surgery.
Department of Molecular Oncology, Tokyo Medical and Dental University, Tokyo, Japan.
Medicine (Baltimore). 2021 May 7;100(18):e25704. doi: 10.1097/MD.0000000000025704.
Splenic artery originating from the superior mesenteric artery is extremely rare. Because of this, its significance in laparoscopic distal pancreatectomy has never been reported. Here, we present the first case of laparoscopic distal pancreatectomy in a patient with a splenic artery arising from the superior mesenteric artery.
A 46-year-old Japanese woman with type 2 diabetes mellitus presented with worsening glycemic control. Abdominal ultrasonography revealed a pancreatic tail mass.
The patient was diagnosed with pancreatic neuroendocrine tumor by endoscopic ultrasound-guided fine needle aspiration. Preoperative computed tomography showed that the splenic artery with branches of dorsal pancreatic artery originated from the superior mesenteric artery.
The patient underwent laparoscopic distal pancreatectomy. Prior to pancreatectomy, the splenic artery and its dorsal pancreatic branches were clamped using the superior and inferior approaches, respectively, to avoid bleeding and congestion.
The postoperative course was uneventful.
Preoperative evaluation of anatomical variants and development of strategies are important to avoid intraoperative complications in pancreatic surgery. Our results revealed that laparoscopic distal pancreatectomy can be performed safely by strategic approach even in a patient with a rare aberrant splenic artery.
发自肠系膜上动脉的脾动脉极其罕见。因此，其在腹腔镜胰体尾切除术的意义尚未见报道。在此，我们报告首例发自肠系膜上动脉的脾动脉的腹腔镜胰体尾切除术病例。
一名 46 岁日本女性，患有 2 型糖尿病，血糖控制恶化。腹部超声检查发现胰尾部肿块。
内镜超声引导下细针抽吸活检诊断为胰腺神经内分泌瘤。术前 CT 显示脾动脉及其背侧胰支发自肠系膜上动脉。
患者接受腹腔镜胰体尾切除术。在胰体尾切除术前，采用上、下方法分别夹闭脾动脉及其背侧胰支，以避免出血和淤血。
术后过程顺利。
术前评估解剖变异并制定策略对于避免胰腺手术中的术中并发症很重要。我们的结果表明，即使存在罕见的脾动脉异常，通过策略性方法也可以安全地进行腹腔镜胰体尾切除术。
