Tsuzuki Yukihiro, Ooshiro Kiyotetsu, Tatekawa Yukihiro, Tamashiro Rin, Yagi Takeshi, Higa Takeshi
Department of Pediatric Surgery, Okinawa Nanbu Medical Center & Children's Medical Center, 118-1, Arakawa, Shimajiri, Haebaru, Okinawa, 901-1193, Japan.
Department of Pediatric Hematology/Oncology, Okinawa Nanbu Medical Center & Children's Medical Center, 118-1, Arakawa, Shimajiri, Haebaru, Okinawa, 901-1193, Japan.
Surg Case Rep. 2024 Oct 24;10(1):243. doi: 10.1186/s40792-024-02047-w.
Pediatric pancreatic tumors, especially with duodenal invasion, are exceptionally rare and a strategy for their treatment has not been established. A pancreaticoduodenectomy is often the desired treatment, but may be over-invasive for solid pseudopapillary neoplasm (SPN). This study reports an innovative surgical approach for SPN with duodenal invasion using pancreatic enucleation and endoscopically guided partial duodenectomy.
An 11-year-old girl complained of malaise and presented with severe anemia; imaging revealed a tumor of undetermined origin, involving the pancreatic head and descending duodenum. Intraoperative findings showed tumor adherence to the pancreatic head and endoscopy revealed invasion of the duodenum. The tumor was enucleated from the pancreatic head, and partial duodenectomy was performed under endoscopically guided direct visualization. Pathology confirmed SPN with duodenal invasion, and no residual tumor. Although a Grade B pancreatic fistula occurred postoperatively, it was managed conservatively. At the 15-month follow-up, no signs of tumor recurrence, duodenal stenosis, or pancreatic dysfunction were evident.
Given the good prognosis of SPN, we believe that enucleation from the pancreatic head combined with an endoscopically guided partial duodenectomy could be a useful and less invasive alternative to pancreaticoduodenectomy for cases with duodenal invasion.
小儿胰腺肿瘤，尤其是侵犯十二指肠的肿瘤极为罕见，尚未确立其治疗策略。胰十二指肠切除术通常是理想的治疗方法，但对于实性假乳头状肿瘤（SPN）可能侵袭性过大。本研究报告了一种针对侵犯十二指肠的SPN的创新手术方法，即采用胰腺摘除术和内镜引导下十二指肠部分切除术。
一名11岁女孩主诉身体不适并伴有严重贫血；影像学检查发现一个起源不明的肿瘤，累及胰头和十二指肠降部。术中发现肿瘤与胰头粘连，内镜检查显示十二指肠受侵。肿瘤从胰头摘除，并在内镜引导下直接可视化下行十二指肠部分切除术。病理证实为侵犯十二指肠的SPN，且无残留肿瘤。尽管术后发生了B级胰瘘，但经保守治疗。在15个月的随访中，未发现肿瘤复发、十二指肠狭窄或胰腺功能障碍的迹象。
鉴于SPN预后良好，我们认为对于侵犯十二指肠的病例，从胰头摘除肿瘤并联合内镜引导下十二指肠部分切除术可能是一种有用且侵入性较小的替代胰十二指肠切除术的方法。
