Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe University Hospital/International Clinical Cancer Research Center, 1-5-1 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan.
Clin J Gastroenterol. 2021 Dec;14(6):1749-1755. doi: 10.1007/s12328-021-01493-5. Epub 2021 Aug 3.
A 68-year-old man who had undergone distal gastrectomy for gastric cancer 3 years previously, presented to our hospital for examination of dilatation of the main pancreatic duct on follow-up computed tomography and magnetic resonance cholangiopancreatography. After examination, he was diagnosed with early-stage pancreatic cancer and distal pancreatectomy (DP) was planned. With informed consent, we performed indocyanine green (ICG) fluorography during DP and digital subtraction angiography (DSA) of vessels supplying the remnant stomach immediately before and after DP. On ICG fluorography, the remnant stomach gradually became fluoresced starting at the area of the lesser curvature, and the fluorescence eventually intensified over the entire area of the remnant stomach to the same brightness as that of the liver and duodenum. On DSA following DP, the terminal branches of the left inferior phrenic artery (LIPA) were distributed to more than half of the area of the remnant stomach, centering around the proximal area. It is useful to confirm blood flows to the remnant stomach by ICG fluorography using a near-infrared imaging camera during DP. We found that the LIPA played an important role in maintaining the blood supply to the remnant stomach in the absence of the left gastric artery and splenic artery.
一位 68 岁男性，3 年前因胃癌行远端胃切除术，在后续的计算机断层扫描和磁共振胰胆管成像检查中发现主胰管扩张，来我院就诊。检查后诊断为早期胰腺癌，计划行胰远端切除术（DP）。在获得知情同意后，我们在 DP 期间进行了吲哚菁绿（ICG）荧光造影，并在 DP 前后立即进行了供应残胃的血管数字减影血管造影（DSA）。在 ICG 荧光造影中，残胃从胃小弯开始逐渐出现荧光，荧光最终在整个残胃区域增强，与肝脏和十二指肠的亮度相同。在 DP 后的 DSA 中，左膈下动脉（LIPA）的终末支分布在残胃的一半以上区域，以近端区域为中心。在 DP 期间使用近红外成像相机进行 ICG 荧光造影，有助于确认残胃的血流。我们发现，在没有胃左动脉和脾动脉的情况下，LIPA 在维持残胃的血液供应方面发挥了重要作用。
