膵体尾部脂肪置換を合併した膵神経内分泌腫瘍に対する腹腔鏡下膵部分切除術の1例

A case of pancreas neuroendocrine tumor with fatty replacement of pancreatic tail and body treated by laparoscopic central pancreatectomy

◆要旨：患者は79歳，女性．腹部膨満感で受診し，精査にてS状結腸癌による閉塞性イレウスと診断した．腹部造影CT検査で膵体部に多血性腫瘍を認め，その尾側は脂肪に置換されていた．S状結腸癌および膵体尾部脂肪置換を合併した膵神経内分泌腫瘍と診断し，腹腔鏡下S状結腸切除術，膵中央切除術を施行した．手術所見では膵体部腫瘍の尾側は分厚い脂肪組織に置換されていた．尾側膵との消化管吻合は行わなかった．膵腫瘍は組織学的には膵神経内分泌腫瘍であり，尾側膵はランゲルハンス島細胞を散在性に認めるのみであった．術後膵瘻は認めず，耐糖能異常を認めなかった．脂肪置換により尾側膵の再建なしに腹腔鏡下膵中央切除を安全に施行することができた．

A 79-year-old female was referred to our hospital with complaint of abdominal distention. A close inspection led to a diagnosis of occlusive ileus due to sigmoid colon cancer. An abdominal contrasting CT scan revealed a plethoric tumor mass in the pancreas body, and showed the fatty replacement of the caudalis of the tumor. The pre-operational diagnosis was sigmoid colon carcinoma and pancreas neuroendocrine tumor（NET） with fatty replacement of the pancreatic tail and body. We performed a laparoscopic sigmoid colon resection and central pancreatectomy. We found the tumor in the pancreas body, and the caudalis of the pancreas was replaced by thick adipose tissue. We did not perform a gastrointestinal anastomosis with the pancreatic tail and body. Histologically, the pancreas tumor was NET, and only the islets of Langerhans cells were found in the adipose tissue. No postoperative pancreatic fistula, nor postoperative impaired glucose tolerance has occurred. We safely performed a laparoscopic central pancreatectomy to fatty replaced pancreas, with no gastrointestinal anastomosis with the pancreatic tail and body.