膵囊胞性疾患の外科治療

Surgical Treatment of Cystic Lesions of the Pancreas

要旨　1976年1月から1989年8月までの13年8か月間に当教室で治療を行った膵疾患は271例である．このうち21例が分枝型あるいは囊胞形成型の粘液産生疾患で，26例が仮性囊胞を伴った膵疾患であった．粘液産生疾患に対しては，腫瘍や病変の進展範囲を十分診断したうえで，膵切除範囲や郭清の程度を決定している．膵切除術式は，頭部切除（PD）13例，体尾部切除7例，体部切除1例であった．病理診断は，癌5例（いずれも粘膜内癌），腺腫8例，過形成8例である．膵病変再発例はなく，quality of lifeはPDの1例を除き良好であった．仮性囊胞26例のうち，23例は慢性膵炎に起因し，3例は膵癌に随伴したものである．慢性膵炎に対する外科治療は膵温存術式を基本としており，囊胞合併例においては囊胞の部位や膵管との交通の有無あるいは主膵管拡張の有無などによって術式を選択している．施行した術式は，膵体尾部切除10例，Puestow手術5例，Partington手術4例，その他4例である．17例の消息が判明しており，14例が現在社会復帰している．膵癌に随伴した仮性囊胞の3例では，2例に根治手術を施行でき，術後7か月と14か月生存した．

　From January, 1976 through August, 1989, surgical treatment was undertaken in 271 cases of pancreatic diseases including 21 cystic mucin-producing lesions and 26 pseudocysts.

　The mucin-producing lesions consisted of five mucosal carcinomas, eight adenomas and eight mucosal hyperplasias. Pancreatoduodenectomy was performed in 13 cases, distal pancreatectomy in seven and body resection in one. No patient has died of reccurrence of the pancreatic lesions, but four died from other miscellaneous diseases. Excluding incidental cases, a five year survival rate was 87%.

　Twenty-three lesions of pseudocysts were associated with chronic pancreatitis, and three with carcinoma of the pancreas. Four lesions of pseudocysts were located in the head of the pancreas, seven in the body, and 15 in the tail. Surgical procedures for pancreatitis-induced pseudocyst included distal pancreatectomy in ten cases, Puestow's operation in five, Partington's operation in four, and other procedures in four. The outcome after surgery was good in 14 out of 17 patients with known postoperative course. In two cases of pancreas carcinoma, curative operation was performed resulting in the survival periods of 7 and 14 months.