腹腔鏡下膵鉤部部分切除術に際し膵液瘻予防目的に膵空腸吻合術を行った1例

A case of laparoscopic local resection of pancreatic tumor followed by pancreatojejunostomy to prevent pancreatic fistula

◆要旨：患者は53歳，女性．心窩部痛を主訴に精査を行い，膵鉤部に12mmの血流に富む腫瘤を指摘された．超音波内視鏡下生検で確定診断には至らなかったが，膵神経内分泌腫瘍が疑われたため，腹腔鏡下膵部分切除術を施行した．主膵管損傷を認めなかったが，膵実質欠損が大きかったため欠損部に空腸をRoux-Y式に吻合した．手術時間は435分，出血量は50gであった．術後感染性腸炎を認めたが軽快し，術後25日目に退院した．術後病理診断は漿液性囊胞腺腫であった．膵局所切除術に際して膵実質欠損部が大きく膵液瘻が懸念される場合に，膵空腸吻合術は有用であり，腹腔鏡下にも安全に行える手技であると思われた．

A 53-year-old women complaining of upper abdominal pain was admitted to the hospital. Computed tomography showed an enhanced tumor measuring 12mm in the pancreatic uncinated process. Based on the diagnosis of pancreas neuroendocrine tumor, laparoscopic local resection was performed. The pancreatic duct injury was not noted, while defect of the pancreas parenchyma was large and thus the patient additionally underwent pancreatojejunostomy to cover defect in a Roux-Y fashion. The duration of operation was 435 minutes, and estimated blood loss was 50g. There was no severe postoperative event except for mild enteritis. The pathological diagnosis was solid type serous cyst adenoma. Pancreatojejunostomy for large defect of pancreatic parenchyma after local resection is useful to prevent postoperative pancreatic fistula, and can be safely performed by laparoscopic procedure.