Okamura K, Hayakawa H, Kusagawa M, Takahashi H, Kosaka A, Katsuta K, Mizumoto R
Department of Surgery and Pathology, Matsusaka City Hospital, Mie, Japan.
Int J Pancreatol. 1998 Oct;24(2):133-8. doi: 10.1007/BF02788572.
The case of a 91-yr-old man who had a tumor of the pancreas head successfully resected is reported. He was admitted to our hospital because of obstructive jaundice, and then percutaneous transhepatic biliary drainage (PTBD) was performed. Cholangiography via PTBD tube showed marked stenosis of the bile duct in the head of the pancreas. Endoscopic retrograde pancreatography (ERP) showed obstruction of the main pancreatic duct in the head of the pancreas, and carcinoma in the head of the pancreas was diagnosed. Abdominal angiography showed stenosis of the celiac trunk caused by compression from the median arcuate ligament, but no tumor stain or encasement in the pancreas was detected. Because the patient had lived an extremely healthy life and had no serious concurrent disease before admission, laparotomy was performed. The tumor in the head of the pancreas was about 2 cm in diameter and restricted inside the pancreas. Pylorus-preserving pancreatoduodenectomy (PpPD) with regional lymph node dissection was performed. The tumor was 1.5 cm in its maximal diameter, and histopathologically was diagnosed as an invasive ductal carcinoma of the pancreas with moderately differentiated tubular adenocarcinoma. The patient had an uneventful postoperative course and now, 3 yr after surgery, he is doing very well and leading a normal daily life.
报告了一例91岁男性胰头肿瘤成功切除的病例。他因梗阻性黄疸入院，随后进行了经皮肝穿刺胆道引流术（PTBD）。经PTBD管进行的胆管造影显示胰头胆管明显狭窄。内镜逆行胰胆管造影（ERP）显示胰头主胰管梗阻，诊断为胰头癌。腹部血管造影显示腹腔干因中弓状韧带压迫而狭窄，但未检测到胰腺有肿瘤染色或包绕。由于患者入院前生活极其健康且无严重合并症，故行剖腹手术。胰头肿瘤直径约2 cm，局限于胰腺内。行保留幽门的胰十二指肠切除术（PpPD）并进行区域淋巴结清扫。肿瘤最大直径为1.5 cm，组织病理学诊断为胰腺浸润性导管癌伴中度分化管状腺癌。患者术后恢复顺利，术后3年，目前情况良好，过着正常的日常生活。
