环主动脉胰腺的微创胰十二指肠切除术:文献综述和两例 IIIA 型病例的报告。

IF 0.7 Q4 SURGERY
Hajime Imamura, Tomohiko Adachi, Mampei Yamashita, Ayaka Kinoshita, Takashi Hamada, Hajime Matsushima, Takanobu Hara, Akihiko Soyama, Kazuma Kobayashi, Kengo Kanetaka, Susumu Eguchi
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引用次数: 0

摘要

背景:环状门脉胰腺是一种罕见的形态变异,由于接受胰十二指肠切除术的患者术后出现胰瘘的风险很高,因此具有重要的临床意义。IIIA型(脾上前门)是最常见的环状门脉胰腺类型。我们介绍了两例采用微创胰十二指肠切除术治疗的 IIIA 型胰腺,并回顾了有关接受胰腺手术的环状门脉胰腺患者的文献:病例 1:腹腔镜胰十二指肠切除术治疗无功能的胰腺神经内分泌肿瘤伴胰岛外膜环。一名 69 岁女性,无病史,常规超声检查发现胰头肿块。CT 显示胰腺头部有一个 20 毫米的高血管肿瘤,胰腺脾上环有一个门前导管。主胰管(MPD)不在门静脉(PV)背侧的实质内。患者接受了腹腔镜胰十二指肠切除术。门静脉前侧用超声波装置切除,门静脉后侧用网状加固订书机切除。胰空肠吻合术顺利完成,无并发症发生。病例 2:机器人辅助胰十二指肠切除术,治疗胰头癌和胰尾无功能的胰腺神经内分泌肿瘤,伴有环状门脉胰腺。一名无病史的 72 岁男性,超声检查发现主胰管扩张。他被诊断为胰头癌(IIA 期),接受了新辅助化疗。对比增强 CT 显示头部有胰腺癌,尾部有一个病理不明的肿瘤。他接受了机器人辅助胰十二指肠切除术,并计划对尾部肿瘤左侧进行胰腺切除。术中发现胰腺呈环状,胰十二指肠未穿过背侧实质。切除尾部肿瘤左侧的实质后,使用 SynchroSeal® 剥离了腹腔静脉背侧的实质。胰腺空肠吻合术顺利完成,无并发症发生。术后恢复顺利:结论:应根据环主动脉胰腺的类型和切除病灶的位置选择最佳的胰腺切除位置和方法,以最大限度地降低胰瘘的风险。即使是经验丰富、技术娴熟的外科团队,环主动脉胰腺微创手术仍具有挑战性,因此在应用时必须慎重考虑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Minimally invasive pancreaticoduodenectomy for circumportal pancreas: literature review and report of two type IIIA cases.

Background: Circumportal pancreas is a rare morphological variant with clinical significance due to the high risk of postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy. Type IIIA (suprasplenic anteportal) is the most common type of circumportal pancreas. We present two cases of type IIIA treated with minimally invasive pancreaticoduodenectomy, and review the literature on patients with circumportal pancreas who underwent pancreatic surgery.

Case presentation: Case 1: Laparoscopic Pancreaticoduodenectomy for Non-functioning Pancreatic Neuroendocrine Neoplasm with Circumportal Pancreas. A 69-year-old female with no prior medical history presented with a pancreatic head mass detected during routine ultrasound. CT revealed a 20 mm hypervascular tumor in pancreas head and a suprasplenic circumportal pancreas with an anteportal duct. The main pancreatic duct (MPD) was not in the parenchyma on the dorsal side of the portal vein (PV). Laparoscopic pancreaticoduodenectomy was performed. The anteportal side was resected with an ultrasonic device, and the retroportal side with a mesh-reinforced stapler. Pancreaticojejunostomy was performed without complications. Case 2: Robot-assisted Pancreaticoduodenectomy for Pancreatic Head Cancer and Non-functioning Pancreatic Neuroendocrine Neoplasm in the pancreatic tail with Circumportal Pancreas. A 72-year-old male with no prior medical history presented with a dilated main pancreatic duct on ultrasound. Diagnosed with pancreatic head cancer (Stage IIA), he underwent neoadjuvant chemotherapy. Contrast-enhanced CT revealed pancreatic cancer in the head and a tumor in the tail with unknown pathology. Robot-assisted pancreaticoduodenectomy was performed, and pancreatectomy on the left side of the tail tumor was planned. Intraoperative findings revealed a circumportal pancreas with the MPD not running through the dorsal parenchyma. After resected the parenchyma on the left side of the tail tumor, parenchyma on the dorsal side of the PV was dissected using SynchroSeal®. Pancreaticojejunostomy was performed without complications. The postoperative course was uneventful.

Conclusions: The optimal location and method of pancreatic resection should be selected according to the type of circumportal pancreas and the location of the lesion to be resected to minimize the risk of pancreatic fistula. Minimally invasive surgery for circumportal pancreas remains challenging even for surgical teams with sufficient experience and skills, and careful consideration are necessary for its application.

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