Yamazaki Kazuhiro, Minatoya Kenji, Sakamoto Kazuhisa, Kudo Masafumi, Fukumitsu Ken, Kobayashi Takashi, Okajima Hideaki
Division of Cardiovascular Surgery, Department of Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.
Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Surg Case Rep. 2024 Feb 9;10(1):36. doi: 10.1186/s40792-024-01834-9.
Acute pancreatitis caused by surgical procedures may occur less frequently in surgeries for aortic aneurysm involving the abdominal branch. However, in such cases, the associated mortality rate increases significantly. There have been few reports on abdominal aortic aneurysm surgery after pancreatoduodenectomy; as such the incidence of postoperative pancreatitis remains unclear.
Two cases of pararenal artery aortic aneurysm after pancreaticoduodenectomy and endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm are reported. In the first case, a 74-year-old man was diagnosed with abdominal aortic aneurysm and duodenal cancer 6 years earlier and underwent pancreaticoduodenectomy after EVAR. Subsequently, the abdominal aorta expanded to 58 mm at the level of the renal artery proximal to the EVAR site. Graft replacement was performed through a left thoraco-retroperitoneal incision. However, the patient died from acute pancreatitis, believed to be caused by intraoperative manipulation. Given this initial experience, in the second case, a 77-year-old man had undergone a pancreaticoduodenectomy for a gastrointestinal stromal tumor 17 years earlier and EVAR for an abdominal aortic aneurysm 10 years earlier. The abdominal aorta had expanded to 50 mm immediately below the right renal artery on the proximal side of the EVAR. Subsequently, hematuria was noted, and he was diagnosed with right ureteral cancer. Autologous transplantation of the left kidney and EVAR was performed avoiding manipulation of the area around the pancreas and achieved good results. Combined right renal and ureteral resections were performed 20 days after EVAR.
While performing aortic surgery after pancreaticoduodenectomy, surgeons should avoid manipulating tissues around the pancreas.
在涉及腹部分支的主动脉瘤手术中，手术引起的急性胰腺炎可能较少发生。然而，在这种情况下，相关死亡率会显著增加。关于胰十二指肠切除术后腹主动脉瘤手术的报道很少；因此，术后胰腺炎的发生率仍不清楚。
报告了两例胰十二指肠切除术后肾旁动脉主动脉瘤及腹主动脉瘤腔内修复术（EVAR）的病例。第一例，一名74岁男性6年前被诊断为腹主动脉瘤和十二指肠癌，在接受EVAR后进行了胰十二指肠切除术。随后，腹主动脉在EVAR部位近端肾动脉水平扩张至58毫米。通过左胸腹膜后切口进行人工血管置换。然而，患者死于急性胰腺炎，据信是由术中操作引起的。鉴于这一初步经验，在第二例中，一名77岁男性17年前因胃肠道间质瘤接受了胰十二指肠切除术，10年前因腹主动脉瘤接受了EVAR。腹主动脉在EVAR近端右侧肾动脉下方立即扩张至50毫米。随后出现血尿，他被诊断为右输尿管癌。进行了左肾自体移植和EVAR，避免了对胰腺周围区域的操作，取得了良好效果。在EVAR后20天进行了右肾和输尿管联合切除术。
在胰十二指肠切除术后进行主动脉手术时，外科医生应避免操作胰腺周围的组织。
