Yokono Yoshinori, Komatsu Hisateru, Sugimoto Tomoki, Hirano Masataka, Nishizawa Yujiro, Inoue Akira, Kagawa Yosinori, Miyazaki Yasuhiro, Tomokuni Akira, Fushimi Hiroaki, Motoori Masaaki, Fujitani Kazumasa, Iwase Kazuhiro
Dept. of Gastroenterological Surgery, Osaka General Medical Center.
Gan To Kagaku Ryoho. 2022 Feb;49(2):192-194.
A male in his twentieth was referred to our hospital for jaundice. Computed tomography(CT)showed dilation of the intrahepatic and extrahepatic bile ducts and showed a lesion at the ampulla of Vater, which caused obstructive jaundice. Upper gastrointestinal endoscopy revealed a tumor of protruded-predominant type with raised margins at the ampulla of Vater, and biopsy from the lesion indicated malignancy. With no apparent distant metastasis, radical resection was assumed to be possible, thus we performed subtotal stomach preserved pancreatoduodenectomy. Before the operation, endoscopic retrograde biliary drainage(ERBD)was unsuccessful because of the existence of the tumor, so percutaneous transhepatic cholangio drainage(PTCD)was conducted. After the operation, although pancreatic fistula(ISGPF Grade B)occurred, it improved with conservative treatment, and he discharged at 30 postoperative days. Histopathological examination revealed signet-ring cell carcinoma among the tumor at the ampulla of Vater, which was infiltrating into the pancreas. Final diagnosis was pT3, pN0, M0, pStage ⅡA. Now he is alive without recurrence for 3 and a half years.
一名20岁男性因黄疸被转诊至我院。计算机断层扫描（CT）显示肝内和肝外胆管扩张，并显示在 Vater 壶腹处有一个病变，导致梗阻性黄疸。上消化道内镜检查显示 Vater 壶腹处有一个以突出为主型的肿瘤，边缘隆起，病变活检提示为恶性。由于无明显远处转移，推测可行根治性切除，因此我们进行了保留胃的胰十二指肠次全切除术。术前，由于肿瘤的存在，内镜逆行胆管引流（ERBD）未成功，因此进行了经皮经肝胆管引流（PTCD）。术后，虽然发生了胰瘘（国际胰腺外科研究组胰瘘分级为B级），但经保守治疗后好转，术后30天出院。组织病理学检查显示 Vater 壶腹处肿瘤中有印戒细胞癌，肿瘤已浸润至胰腺。最终诊断为pT3、pN0、M0、pⅡA期。目前他存活3年半，无复发。
