Hirano Naohiro, Iseki Masahiro, Morikawa Takanori, Umino Yuuichiro, Aoki Shuichi, Inoue Koetsu, Nakayama Shun, Miura Takayuki, Masuda Kunihiro, Ishida Masaharu, Ohtsuka Hideo, Mizuma Masamichi, Nakagawa Kei, Kume Kiyoshi, Masamune Atsushi, Kamei Takashi, Unno Michiaki
Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Miyagi, 980-8574, Sendai, Japan.
Department of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Surg Case Rep. 2022 Jun 30;8(1):127. doi: 10.1186/s40792-022-01463-0.
Cavernous transformation of the portal vein (CTPV) due to extrahepatic portal vein obstruction is a rare vascular anomaly. Since its symptoms usually appear in childhood, most of the adult cases are detected unexpectedly with other diseases. Only a few reports have described surgical difficulties in patients with CTPV. We report a case of pancreatic head cancer with CTPV in a patient who underwent pancreaticoduodenectomy.
A 77-year-old man with epigastric and back pain was referred to our hospital. Computed tomography revealed a tumor in the pancreatic head and a CTPV near the hepatic hilum. CTPV consisted of two main collateral vessels connected by multiple surrounding small vessels. Also, portal vein obstruction was observed near the hepatic hilum, which was far from the pancreatic head tumor. After confirming that there was no distant metastasis by a thorough whole-body search, we performed a pancreaticoduodenectomy following neoadjuvant chemotherapy. During the operation, we carefully manipulated the area of the CTPV and omitted lymph node dissection in the hepatoduodenal ligament to prevent massive venous bleeding and intestinal congestion. Pancreaticoduodenectomy was performed without any intraoperative complications and the postoperative course was uneventful. Complete tumor resection was histologically confirmed.
Although pancreaticoduodenectomy for patients with CTPV involves many surgical difficulties, we successfully performed it by determining specific treatment strategies tailored to the patient and following careful and delicate surgical procedures.
肝外门静脉阻塞所致的门静脉海绵样变性（CTPV）是一种罕见的血管异常。由于其症状通常在儿童期出现，大多数成人病例是在患其他疾病时意外发现的。仅有少数报告描述了CTPV患者的手术困难。我们报告一例接受胰十二指肠切除术的CTPV合并胰头癌患者。
一名77岁男性，因上腹部和背部疼痛转诊至我院。计算机断层扫描显示胰头有肿瘤，肝门附近有CTPV。CTPV由两条主要侧支血管组成，通过多个周围小血管相连。此外，在远离胰头肿瘤的肝门附近观察到门静脉阻塞。在通过全面的全身检查确认无远处转移后，我们在新辅助化疗后进行了胰十二指肠切除术。手术过程中，我们小心处理CTPV区域，并省略了肝十二指肠韧带的淋巴结清扫，以防止大量静脉出血和肠道充血。胰十二指肠切除术顺利完成，术中无并发症，术后恢复顺利。组织学检查证实肿瘤完全切除。
尽管CTPV患者的胰十二指肠切除术存在诸多手术困难，但我们通过为患者制定特定的治疗策略并遵循细致入微的手术操作，成功完成了手术。
