内容紹介
Summary
A 66-year-old Japanese woman was admitted to our hospital for jaundice. Abdominal computed tomography(CT)showed dilatation of the intra- and extra-hepatic bile duct, and a hypovascular lesion measuring 30 mm in diameter in the head of the pancreas. This tumor was in contact with the(superior mesenteric vein: SMV)and(inferior vena cava: IVC), but there were no obvious signs of invasion. Upper gastrointestinal endoscopy showed obstruction of the duodenum. We chose to perform an upfront surgery, considering the patient's general condition being stable and the difficulties associated with endoscopic biliary drainage. During surgery, stiff attachment between the tumor and IVC was identified and wedge resection of the IVC wall was performed. SMV resection and end-to-end reconstruction were also carried out. Pathological studies of the surgical specimen revealed direct invasion by the pancreatic adenocarcinoma into the adventitia of the IVC. The postoperative course was uneventful, and the patient was discharged from the hospital on the 27th postoperative day; she underwent adjuvant chemotherapy(S-1 100 mg/day)and is still alive without tumor recurrence, 21 months after surgery. Cases of resected pancreatic adenocarcinoma directly invading the IVC are rare. In this case, pancreaticoduodenectomy along with wedge resection of the IVC wall could safely be performed, and no complications were observed. There is a need for further accumulation of similar cases.
要旨
症例は66歳,女性。皮膚黄染を主訴に当院を受診した。腹部CTでは肝内胆管の拡張を認め,膵頭部に30 mm大の乏血性の不整腫瘤を指摘された。腫瘍は上腸間膜静脈(SMV)や下大静脈(IVC)に接してはいたが,明らかな浸潤は認めなかった。上部消化管内視鏡検査では十二指腸に全周性の狭窄を認めた。内視鏡的な減黄処置が困難で,全身状態は良好であり手術先行の方針とした。術中所見ではIVCへの浸潤が疑われたため,楔状切除を行った。SMVについても浸潤が疑われ,合併切除および再建を施行した。病理組織学的にIVCの外膜まで浸潤が認められた。術後経過は問題なく,27日目に軽快退院となった。その後,術後補助化学療法としてS-1(100 mg/day)を投与し,術後21か月で無再発生存中である。膵頭部癌ではIVCへの直接浸潤の頻度はまれである。本症例ではIVC合併切除に関連した合併症なく経過した。今後,症例の集積が望まれる。
目次
A 66-year-old Japanese woman was admitted to our hospital for jaundice. Abdominal computed tomography(CT)showed dilatation of the intra- and extra-hepatic bile duct, and a hypovascular lesion measuring 30 mm in diameter in the head of the pancreas. This tumor was in contact with the(superior mesenteric vein: SMV)and(inferior vena cava: IVC), but there were no obvious signs of invasion. Upper gastrointestinal endoscopy showed obstruction of the duodenum. We chose to perform an upfront surgery, considering the patient's general condition being stable and the difficulties associated with endoscopic biliary drainage. During surgery, stiff attachment between the tumor and IVC was identified and wedge resection of the IVC wall was performed. SMV resection and end-to-end reconstruction were also carried out. Pathological studies of the surgical specimen revealed direct invasion by the pancreatic adenocarcinoma into the adventitia of the IVC. The postoperative course was uneventful, and the patient was discharged from the hospital on the 27th postoperative day; she underwent adjuvant chemotherapy(S-1 100 mg/day)and is still alive without tumor recurrence, 21 months after surgery. Cases of resected pancreatic adenocarcinoma directly invading the IVC are rare. In this case, pancreaticoduodenectomy along with wedge resection of the IVC wall could safely be performed, and no complications were observed. There is a need for further accumulation of similar cases.
要旨
症例は66歳,女性。皮膚黄染を主訴に当院を受診した。腹部CTでは肝内胆管の拡張を認め,膵頭部に30 mm大の乏血性の不整腫瘤を指摘された。腫瘍は上腸間膜静脈(SMV)や下大静脈(IVC)に接してはいたが,明らかな浸潤は認めなかった。上部消化管内視鏡検査では十二指腸に全周性の狭窄を認めた。内視鏡的な減黄処置が困難で,全身状態は良好であり手術先行の方針とした。術中所見ではIVCへの浸潤が疑われたため,楔状切除を行った。SMVについても浸潤が疑われ,合併切除および再建を施行した。病理組織学的にIVCの外膜まで浸潤が認められた。術後経過は問題なく,27日目に軽快退院となった。その後,術後補助化学療法としてS-1(100 mg/day)を投与し,術後21か月で無再発生存中である。膵頭部癌ではIVCへの直接浸潤の頻度はまれである。本症例ではIVC合併切除に関連した合併症なく経過した。今後,症例の集積が望まれる。