腹腔鏡下膵体尾部切除術を施行したportal annular pancreasを伴う膵神経内分泌腫瘍の1例

A case of pancreatic neuroendocrine tumor with portal annular pancreas treated by laparoscopic distal pancreatectomy

◆要旨：症例は48歳，女性．健診異常の精査目的でのCTで膵尾部に30×35 mmの腫瘍を認めた．ソマトスタチン受容体シンチグラフィーで強集積を認め，神経内分泌腫瘍と診断された．また，膵鉤部が門脈背側を回り膵体部背側に癒合する膵奇形であるportal annular pancreas（PAP）を伴っていた．腹腔鏡下膵体尾部切除術を施行した．膵切離位置は，切除マージンと実質の厚さを考慮し，癒合部左側の1面切離ではなく門脈左縁レベルでの腹側・尾側の2面切離を選択した．膵液瘻を含む合併症なく術後9日目に退院となった．PAP症例に対する膵切除術は膵液瘻リスクと関連するとされており，文献的考察を加えて報告する．

　A 48-year-old woman was diagnosed with a 30×35mm tumor in the tail of the pancreas on computed tomography（CT）. Somatostatin receptor scintigraphy showed strong accumulation ; thus, she was diagnosed with a neuroendocrine tumor. The patient also had a portal annular pancreas （PAP）—a pancreatic malformation in which the uncinate process of the pancreas is wrapped around the dorsal side of the portal vein and fused to the pancreatic body. A laparoscopic distal pancreatectomy was performed. Owing to the resection margin and thickness of the parenchyma, the location of the pancreatic resection was determined to be the two planes of the ventral and distal sides at the level of the left border of the portal vein, rather than the distal part of the fused area. The patient was discharged on postoperative day 9 without any complications, including a pancreatic fistula. Pancreatic resection for PAP has been reported to be associated with the risk of pancreatic fistula, and we report the present case with a literature review.