腹腔鏡下脾動静脈温存膵体尾部切除術後に胃静脈瘤をきたした1例

A case of gastric varices after laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation

◆要旨：症例は32歳，男性で，膵尾部solid-pseudopapillary neoplasmに対して脾動静脈を温存する腹腔鏡下膵体尾部切除術を施行した．POD8の造影CTで膵断端に限局性の液貯留と脾静脈の狭小化を認めたが，感染徴候はなく追加ドレナージは行わなかった．POD10に腹痛の増強があったが，再検したCTで液貯留の拡大はなく経過観察とし，軽快しPOD19に退院となった．術後4か月のCTで，膵断端の液貯留は消失していたが脾静脈が途絶しており，胃静脈瘤と脾腫を認めた．術後24か月現在，臨床症状なく慎重に外来経過観察中である．脾動静脈温存膵体尾部切除術後の胃静脈瘤の報告は比較的稀であり，文献的考察を加えて報告する．

　A 32-year-old man underwent laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation for solid-pseudopapillary neoplasm in the tail of the pancreas. CT scan of POD8 showed local fluid collection at the pancreatic stump and narrowing of the splenic vein. There were no signs of infection, and additional drainage was not attempted. Abdominal pain increased at POD10, but reexamination of CT revealed no expansion of fluid collection, and the symptom was relieved and the patient discharged on POD19. Four months after the operation, CT showed that the effusion had disappeared, but the splenic vein was occluded, and gastric varices and splenomegaly were observed. 24 months after the operation, the patient is under careful follow-up without any clinical symptoms and recurrence of the tumor. Since reports of gastric varices after distal pancreatic resection with splenic vessels preservation are relatively rare, we report the case with review of the literatures.