Sotomayor Camila, Sagredo Herta N, Jarufe Alessandra, Viñuela Eduardo, Jarufe Nicolás, Martínez Jorge, Briceño Eduardo, Dib Martín
Department of Hepatobiliary and Pancreatic Surgery, Pontificia Universidad Católica de Chile, Santiago, CHL.
Division of Transplantation, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
Cureus. 2024 Dec 4;16(12):e75081. doi: 10.7759/cureus.75081. eCollection 2024 Dec.
Pancreatoduodenectomy and distal pancreatectomy are standard treatments for various pancreatic pathologies. These procedures involve radical resection and a significant loss of pancreatic tissue, which can lead to exocrine and/or endocrine pancreatic insufficiency. In selected cases of benign tumors or those with low malignant potential, central pancreatectomy can be performed with acceptable morbidity and mortality rates. The advantage of preserving the maximum amount of healthy pancreatic tissue is the retention of both exocrine and endocrine pancreatic function. We present the case of a 45-year-old female patient with a history of conversion from sleeve gastrectomy to Roux-en-Y gastric bypass three years prior due to gastroesophageal reflux disease (GERD). She presented with a pancreatic cystic lesion incidentally detected during abdominal ultrasound screening. Magnetic resonance imaging (MRI) revealed a 20 mm cystic lesion in the neck of the pancreas without signs of aggressiveness. Endoscopic ultrasound showed no features suggesting malignancy, with aspirated citrine-colored fluid, carcinoembryonic antigen (CEA) < 1.8 ng/mL, amylase of 144 U/L, glucose of 102 mg/dL, and cytology positive for neuroendocrine tumor of the pancreas (pNET). A PET scan with octreotide showed hyperuptake in the pancreas, with no evidence of additional lesions. An open central pancreatectomy was performed without complications. The patient had a favorable postoperative course and was discharged on day 5 without a pancreatic fistula. Biopsy confirmed a well-differentiated 2.1 cm grade 1 neuroendocrine tumor (G1 NET). Surgical margins were negative, with no vascular, lymphatic, or perineural invasion (pT2N0). At the five-month follow-up, the patient was asymptomatic, with a control abdominal PET-CT showing no abnormalities. A retrospective review of the patient's medical records and a literature review were performed.
胰十二指肠切除术和远端胰腺切除术是治疗各种胰腺疾病的标准方法。这些手术涉及根治性切除，会导致大量胰腺组织丢失，进而可能引发胰腺外分泌和/或内分泌功能不全。在某些良性肿瘤或恶性潜能较低的病例中，可进行保留胰腺手术，其发病率和死亡率可接受。保留最大量健康胰腺组织的好处是能保留胰腺的外分泌和内分泌功能。我们报告一例45岁女性患者，她三年前因胃食管反流病（GERD）由袖状胃切除术转为Roux-en-Y胃旁路术。她在腹部超声筛查时偶然发现胰腺囊性病变。磁共振成像（MRI）显示胰腺颈部有一个20毫米的囊性病变，无侵袭迹象。内镜超声未显示提示恶性的特征，抽出的液体为柠檬色，癌胚抗原（CEA）<1.8 ng/mL，淀粉酶为144 U/L，葡萄糖为102 mg/dL，细胞学检查胰腺神经内分泌肿瘤（pNET）呈阳性。用奥曲肽进行的PET扫描显示胰腺有高摄取，无其他病变证据。进行了开放性保留胰腺手术，无并发症。患者术后恢复良好，第5天出院，无胰瘘。活检证实为一个2.1厘米高分化1级神经内分泌肿瘤（G1 NET）。手术切缘阴性，无血管、淋巴管或神经周围侵犯（pT2N0）。在五个月的随访中，患者无症状，腹部PET-CT复查无异常。我们对患者的病历进行了回顾性分析并进行了文献复习。
