[症例報告]上腸間膜動脈浸潤および上腸間膜静脈分岐部浸潤を伴った進行膵鈎部癌に対する拡大手術の1例

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The advanced pancreatic carcinoma of the uncus is accompanied by major vascular invasion, including the superior mesenteric vein (SMV) and the superior mesenteric artery (SMA). Surgical resection of such tumors is often abandoned due to the technical difficulty of vascular reconstruction. We herein present the case of an extended resection for advanced pancreatic carcinoma with invasion to both the SMV and SMA, which was performed by a two-step passive bypass of the portal flow using the Anthron bypass tube (VTT type). A 56-year-old male presenting with complaints of abdominal fullness and pain, was diagnosed to have a pancreatic tumor of the uncus. He was thus referred to our department for surgical treatment on January 24, 1997. Abdominal ultrasonography showed a mass at the pancreatic uncus. Enhanced computed tomography revealed an irregular high density area around the low density tumor. Angiography of the SMA showed an encasement of the arterial wall and the portal phase showed extensive invasion of the tumor to the SMV at its bifurcation of the gastro-colic trunk, iliac vein, and jejunal vein. Markedly developed collateral vessels of the marginal colic vein were also obvious. At laparotomy on Feb. 4, 1997, a tumor involving both the SMV and SMA was found to be located at the uncus of the pancreas, without any peritoneal dissemination, liver metastasis or lymph node swelling, which led us to perform a local resection of the tumor. To avoid intestinal congestion during the operation, apassive bypass of the portal flow to the umbilical vein was established in a two-step manner in addition to the normal operative procedures : first to the middle colic vein and then to the SMV. The tumor was successfully resected by a combined resection of the SMV, which was reconstructed by an interposition of the common iliac venous graft, while the tumor, which extended toward the left side beyond the SMA, was separately resected, after a routine pancreatoduodenectomy of the right side of the tumor. Intra-operative radiation to the retroperitoneal neural plexus was also performed after the resection. In conclusion, the above described surgical procedures may be useful as a new strategy for the resection of pancreatic cancer of the uncus.
琉球医学会,Ryukyu Medical Associationの論文

[症例報告]上腸間膜動脈浸潤および上腸間膜静脈分岐部浸潤を伴った進行膵鈎部癌に対する拡大手術の1例

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