Matsuyoshi Takahito, Ikenaga Naoki, Nakata Kohei, Okamoto Daisuke, Matsumoto Takashi, Abe Toshiya, Watanabe Yusuke, Ideno Noboru, Kaku Keizo, Fujimori Nao, Ohuchida Kenoki, Okabe Yasuhiro, Oda Yoshinao, Ishigami Kousei, Nakamura Masafumi
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Maidashi, Fukuoka, Japan.
Surg Case Rep. 2024 Sep 6;10(1):208. doi: 10.1186/s40792-024-02009-2.
Preoperative vascular embolization is an effective strategy for managing meningiomas, neck paragangliomas, renal cell carcinomas, and bone metastasis by reducing the intraoperative bleeding volume and operation time. Although hypervascular tumors also occur in the pancreas, preoperative embolization for these tumors is not commonly practiced. We herein present a case of a giant serous cystic neoplasm (SCN) of the pancreas with significant arterial vascularity that was managed with preoperative interventional radiology and subsequently resected via pancreaticoduodenectomy.
A 60-year-old man presented with an 8-cm hypervascular tumor located at the head of the pancreas, identified as an SCN on pathologic examination. The tumor had increased by 13 mm over 5 years, necessitating surgical intervention. Computed tomography revealed a substantial blood supply to the tumor from the dorsal pancreatic artery and gastroduodenal artery, both branches of the superior mesenteric artery. To mitigate the risk of severe intraoperative bleeding from this giant hypervascular tumor, branches of the dorsal pancreatic artery and gastroduodenal artery were embolized using metallic coils and further secured using a gelatin sponge 1 day prior to pancreatectomy. During the laparotomy, the tumor appeared to have decreased in size, likely because of reduced distension and congestion. Despite significant adhesions to surrounding tissues secondary to prolonged compression and inflammation, the pancreaticoduodenectomy was completed successfully in 5 h and 15 min with blood loss of 763 mL. The patient was discharged on postoperative day 15 without complications.
Preoperative arterial embolization for hypervascular pancreatic tumors might control the risk of massive intraoperative bleeding, contributing to a favorable postoperative outcome. Utilizing interventional radiology for preoperative inflow control is one of the beneficial strategies for pancreatectomy in patients with a giant SCN.
术前血管栓塞是一种有效的治疗策略，可通过减少术中出血量和手术时间来治疗脑膜瘤、颈部副神经节瘤、肾细胞癌和骨转移瘤。尽管胰腺中也会出现富血管肿瘤，但对这些肿瘤进行术前栓塞并不常见。我们在此报告一例胰腺巨大浆液性囊性肿瘤（SCN），其具有显著的动脉血管，通过术前介入放射学进行处理，随后经胰十二指肠切除术切除。
一名60岁男性患者，胰腺头部有一个8厘米的富血管肿瘤，病理检查确诊为SCN。该肿瘤在5年内增大了13毫米，需要进行手术干预。计算机断层扫描显示，肿瘤由肠系膜上动脉的分支胰背动脉和胃十二指肠动脉大量供血。为降低这个巨大富血管肿瘤术中严重出血的风险，在胰十二指肠切除术1天前，使用金属线圈对胰背动脉和胃十二指肠动脉分支进行栓塞，并进一步用明胶海绵加固。剖腹手术时，肿瘤似乎变小了，可能是由于扩张和充血减轻。尽管由于长期压迫和炎症导致与周围组织有明显粘连，但胰十二指肠切除术仍在5小时15分钟内成功完成，失血763毫升。患者术后第15天出院，无并发症。
对富血管胰腺肿瘤进行术前动脉栓塞可能控制术中大量出血的风险，有助于获得良好的术后结果。利用介入放射学进行术前血流控制是巨大SCN患者胰十二指肠切除术的有益策略之一。
