膵囊胞性腫瘍に対して短胃動静脈温存による腹腔鏡下脾温存膵体尾部切除術を施行した1例

Laparoscopic distal pancreatectomy with splenic preservation via preservation of the short gastric vessels for a cystic tumor of the pancreas : a case report

◆要旨：患者は27歳の女性で，膵体部に径25mm大の多房性囊胞性病変を認め，膵粘液性囊胞性腫瘍と診断した．腫瘍は脾静脈に密接していたため，脾動静脈合併切除し，短胃動静脈温存による腹腔鏡下脾温存膵体尾部切除術の方針とした．脾動静脈は根部近傍にて切離し，膵切離には自動縫合器を使用した．短胃動静脈を慎重に温存し，脾臓の温存は可能であった．切除標本の最終病理診断は膵漿液性囊胞性腫瘍のmacrocystic typeであった．術後は膵液瘻，脾梗塞，脾膿瘍等の合併症を認めず良好な経過であった．短胃動静脈温存による腹腔鏡下脾温存膵体尾部切除術は縮小手術の1つの選択肢として有用と考えられた．

　Recent advances in laparoscopic techniques and devices have allowed surgeons to treat pancreatic lesions laparoscopically. A 27-year-old woman was admitted to our hospital with a diagnosis of cystic tumor of the pancreas. Our diagnosis was a mucinous cystic neoplasm which requires resection. We selected laparoscopic distal pancreatectomy with splenic preservation via preservation of the short gastric vessels because the cystic tumor was adjacent to the splenic vein. The pancreas was transected with a laparoscopic linear stapler. By preservation of the short gastric vessels, sufficient blood flow of the spleen was maintained. Histologically, the tumor was diagnosed as serous cystadenoma, macrocystic type. There were no postoperative complications such as pancreatic fistula and splenic infarction. Laparoscopic distal pancreatic resection with splenic preservation via preservation of the short gastric vessels was thought to be safe and feasible procedure for low malignancy lesions located in the pancreatic body and tail.