膵頭十二指腸切除術後慢性期の胸腹部大動脈置換術に際し術後急性膵炎を発症した1例

Acute Pancreatitis after Thoracoabdominal Aortic Aneurysm Repair in Patient Having a History of Pancreaticoduodenectomy；Report of a Case

はじめに　胸腹部大動脈瘤（TAAA）の手術成績は改善傾向にあるが，開胸および腹部操作による大きな手術侵襲に起因したさまざまな消化器系の合併症が報告されている．そのうち急性膵炎の頻度は決して高くないが，発症後の死亡率は高値であることが報告されている1）．われわれは，膵頭十二指腸切除術（PD）の既往を有する症例の慢性期に胸腹部大動脈置換術を行い，術後の急性膵炎を経験した．特殊な病態下における膵炎発症の病態生理に関して文献的考察とともに報告する．

A 76-year-old man who have a history of pancreaticoduodenectomy was admitted to our hospital for surgical treatment of pararenal abdominal aortic aneurysm. He underwent thoracoabdominal aortic aneurysm repair through the Stoney’s thoracoabdominal incision under partial cardiopulmonary bypass. Postoperatively, laboratory examination showed elevated pancreatic amylase and computed tomography revealed acute pancreatitis. Pancreatitis was successfully treated by giving IV protease inhibition and the patient went well thereafter. In patients with a history of pancreaticoduodenectomy, gentle surgical maneuver around the residual pancreas and adequate perfusion of celiac artery during thoracoabdominal aortic aneurysm repair were considered mandatory.