Doita Susumu, Aoki Hideki, Kajioka Hiroki, Tanakaya Kohji, Kawamoto Kenji
Department of Surgery, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atago-Machi, Iwakuni-City, Yamaguchi, 740-8510, Japan.
Department of Cardiovascular Medicine, National Hospital Organization Iwakuni Clinical Center, 1-1-1 Atago-Machi, Iwakuni-City, Yamaguchi, 740-8510, Japan.
Surg Case Rep. 2024 Mar 12;10(1):59. doi: 10.1186/s40792-024-01857-2.
Celiac axis stenosis (CAS) is frequently observed in patients undergoing pancreaticoduodenectomy (PD). This poses challenges because of the potential disruption of the hepatic arterial blood flow.
We present the case of an 81-year-old woman diagnosed with pancreatic head cancer and severe CAS caused by calcification. The patient received neoadjuvant chemotherapy (NAC) and underwent preoperative endovascular stenting of the celiac axis to restore blood flow. After two cycles of NAC, subtotal stomach-preserving PD was performed. An intraoperative assessment of the hepatic arterial blood flow determined that it was well maintained. PD was performed using the standard technique; specialized techniques were not necessary. Importantly, no ischemic complications were encountered.
This case report describes the successful combination of preoperative celiac axis stenting, NAC, and surgical intervention for the management of CAS in an elderly patient with pancreatic cancer. This approach offers a potential solution for maintaining the hepatic arterial blood flow in the presence of CAS without vascular reconstruction, particularly in elderly individuals.
在接受胰十二指肠切除术（PD）的患者中，腹腔干狭窄（CAS）较为常见。由于可能会干扰肝动脉血流，这带来了挑战。
我们报告一例81岁女性患者，诊断为胰头癌并伴有钙化导致的严重CAS。患者接受了新辅助化疗（NAC），并在术前进行了腹腔干血管内支架置入以恢复血流。经过两个周期的NAC后，实施了保留部分胃的胰十二指肠次全切除术。术中对肝动脉血流的评估表明血流维持良好。采用标准技术进行了胰十二指肠切除术；无需特殊技术。重要的是，未出现缺血性并发症。
本病例报告描述了术前腹腔干支架置入、NAC和手术干预成功联合用于治疗老年胰腺癌患者CAS的情况。这种方法为在存在CAS的情况下无需血管重建而维持肝动脉血流提供了一种潜在的解决方案，尤其是在老年患者中。
