膵体尾部脂肪置換により膵再建を要しなかった腹腔鏡下膵頭十二指腸切除術の1例

A case of lower bile duct cancer with fatty replacement of pancreatic tail and body treated by laparoscopic pancreaticoduodenectomy without pancreatic-enteric reconstruction

◆要旨：患者は75歳，男性．元来糖尿病があり，上腹部鈍痛を主訴に来院し，膵体尾部脂肪置換を伴う下部胆管癌と診断した．膵体尾部脂肪置換症例では，膵頭十二指腸切除術（以下，PD）を行う場合，膵は断端閉鎖のみで再建は不要であることが報告されている．膵再建不要という点で有利と考え，腹腔鏡下に亜全胃温存膵頭十二指腸切除術（以下，SSPPD）を行った．膵は門脈左縁で切離し，膵空腸吻合を行わず空置した．術後膵液瘻をきたすことなく，血糖値も安定していた．病理組織学的に，切離断端部の膵組織は外分泌細胞が消失して脂肪に置換され，ランゲルハンス島細胞が散在性に認められた．

　A 75-year-old male with diabetes mellitus was referred for upper-abdominal pain. He was diagnosed as lower bile duct cancer with fatty replacement of pancreatic tail and body. For the fatty replacement of pancreatic tail and body, it has been reported that reconstruction of remnant pancreas is not necessary at pancreaticoduodenectomy. We performed laparoscopic subtotal stomach-preserving pancreaticoduodenectomy, considering the advantage of no pancreatic reconstruction. We dissected the pancreas at the left site of the portal vein, and pancreatic-enteric reconstruction was not performed. He had no postoperative pancreatic fistula, and glucose control was comparatively stable. Histopathologically, the islets of Langerhans remained sporadically, and there were no pancreatic exocrine cells in the resected fat tissue adjacent to the end of the pancreas head.