腹腔鏡下尾側膵亜全摘術を行った輪状膵を伴う混合型膵管内乳頭粘液性腺癌の1例

Laparoscopic subtotal distal pancreatomy in a patient with wide-spread intraductal papillary mucinous carcinoma : A case report

◆要旨：症例は61歳，女性．近医で主膵管の拡張を指摘され，当院へ紹介受診となった．画像検査所見から膵体尾部に主病変を持つ混合型膵管内乳頭粘液性腺癌と診断した．悪性病変は門脈右縁には及ばないと判断し，腹腔鏡下尾側膵亜全摘術を施行した．手術では胃十二指腸動脈を膵実質から遊離し，尾側膵の左側へ牽引することで上腸間膜静脈の右側で膵切離を行い，切離断端も癌陰性を得た．今回われわれは，広範囲に及ぶ膵管内乳頭粘液性腺癌に対して膵機能温存の観点から腹腔鏡下尾側膵亜全摘術を行った1例を経験したため，文献的考察を加えて報告する．

　The patient was a 61-year-old female, and diagnosed with mixed-type intraductal papillary mucinous adenocarcinoma. The tumor was mainly located in the pancreatic body, and widely spread, while endoscopic examination revealed that malignant lesion did not reach the right border of the portal vein. Therefore, the patient underwent laparoscopic subtotal distal pancreatectomy. Separation of the gastroduodenal artery from the pancreatic parenchyma and traction of the parenchyma to the left side allowed division of the parenchyma on the right side of the portal vein. Pathological findings showed negative margin for cancer.