<症例>脾温存膵尾側切除の1例とその考察

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A 58-year-old housewife having a true pancreatic cyst underwent resection of the tail of the pancreas with preservation of the total spleen. The pancreatectomy was carried out without dividing the splenic artery and vein at the hilum of the spleen. Some pancreatic tissues adherent to the hilum remained in situ, and the patient developed a pseudocyst of the pancreas localized in the lower splenic space 10 days after the surgery. Her symptoms such as abdominal pain, etc. subsided with resolution of the cyst, and she was discharged on the 39th postoperative day. Preservation of the total spleen at distal pancreatectomy is theoretically attractive. However, in practice, the dissection of the tail of the pancreas from the hilum of the spleen is difficult. On isolation of the tail from the hilum, three methods have been described ; 1) preservation of the splenic artery and vein, 2) division of the vessels in expectation of the blood flow for the spleen via the left gastroepiploic or short gastric vessels, and 3) division of all vessels at the hilum in expectation of the blood supply from the retroperitoneum. The third method has not been achieved in the recent literature. To complete resection of the pancreatic tissue at the hilum, division of the splenic artery and vein with an added caution to the splenic hemodynamics is mandatory in general. When the remaining pancreatic tissue is atrophied during the procedure of preservation of the splenic artery and vein, complications due to the tissue are seldom encountered. Whereas, owing to a little amount of vivid pancreatic tissue remaining at the hilum, such a complication as shown in this case may occasionally develop.
近畿大学の論文
1988-06-25

<症例>脾温存膵尾側切除の1例とその考察

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