腹腔鏡下脾動静脈温存脾温存膵尾側切除術を施行した膵尾部副脾epidermoid cystの1例

Laparoscopic spleen preserving distal pancreatectomy with preservation of the splenic artery and vein for an epidermoid cyst originating from an intrapancreatic accessory spleen : a case report

◆要旨：患者は44歳の男性．健診のエコーで膵尾部腫瘤と胆囊結石を指摘され，当院に紹介され受診した．CT，MRIで膵尾部に25mm大の囊胞性病変を認め，辺縁は厚く不均一に造影された．主膵管に異常所見はなく，腫瘍マーカーは正常であった．悪性疾患を否定できず，確定診断を兼ねて腹腔鏡下手術を施行した．術中エコー下に腫瘍の局在を確認し，脾動静脈および脾臓を温存して尾側膵を切除した．術後合併症はなく第13病日に退院した．病理診断は膵尾部副脾に発生したepidermoid cystであった．診断を兼ねた膵尾部切除に対して，腹腔鏡下脾動静脈温存・脾温存膵尾側切除術は積極的に考慮すべき術式と考える．

　A 44-year-old male was admitted with a cystic mass in the pancreatic tail and cholecystolithiasis detected by abdominal ultrasonography in a routine physical examination. Abdominal CT and MRI showed a 25 mm cystic lesion with a thick unequally enhanced edge. No abnormal findings were seen in the main pancreatic duct. Serum CEA, CA 19-9 and DUPAN 2 were normal. Since malignant disease could not be denied, we conducted laparoscopic surgery for definite diagnosis. Localization of the tumor was confirmed under intraoperative ultrasonography and spleen preserving distal pancreatectomy with preservation of the splenic artery and vein was performed. There were no postoperative complications and he was discharged on the 13 th day after surgery. Final pathological diagnosis was epidermoid cyst originating from a intrapancreatic accessory spleen. Laparoscopic spleen preserving distal pancreatectomy with preservation of the splenic artery and vein could positively be considered for diagnostic distal pancreatectomy.