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Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein

World Journal of Gastroenterology 2007年第10期13卷 1493-1499页

作者： Wataru Kimura Toshiyuki Moriya Jinfeng Ma Yukinori Kamio Toshihiro Watanabe Mitsukiro Yano Hiroto Fujimoto Koji Tezuka Ichiro Hirai Akira Fuse Gastroenterological and General Surgery (First Department of Surgery)Yamagata University School of Medicine2-2-2 Iida-NishiYamagata CityYamagata 990-9585Japan

PreservaUon of the spleen at distal pancreatectomy has recently attracted considerable attention. Since our first successful trial, spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for tumors of the pancreas and chronic pancreatitis has been performed more frequently. The technique for spleenpreserving distal pancreatectomy with conservation of the splenic artery and vein are outlined. The splenic vein is identified behind the pancreas and within the thin connective tissue membrane. The connective tissue membrane is cut longitudinally above the splenic vein. An important issue is to remove the splenic vein from the body of the pancreas toward the spleen, since a different approach may be very difficult. The pancreas is preferably removed from the splenic artery toward the head of the pancreas itself. This procedure is much easier than removing the pancreas from the vein side. One patient had undergone distal gastrectomy for duodenal ulcer, with reconstruction by Billroth Ⅱ tehcnique. If distal pancreatectomy with splenectomy had been performed for the lesion of the distal pancreas at the time, the residual stomach would also have to be resected. The potential damage done to the patient by reconstruction of the gastrointestinal tract in combination with distal pancreatectomy and splenectomy would have been much greater than with distal pancreatectomy only with preservation of the spleen and residual stomach. Benign lesions as well as low-grade malignancy of the body and tail of the pancreas may be a possible indication for this procedure.

关键词： Spleen preservation intraductal papillary-mucinous neoplasm Splenic artery Splenic vein The fusion fascia of Treitz and Toldt

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Growth process of small pancreatic carcinoma: A case report with imaging observation for 22 months

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World Journal of Gastroenterology 2008年第12期14卷 1958-1960页

作者： Takeshi Hisa Hiroki Ohkubo Satoshi Shiozawa Hiroki Ishigame Masato Takamatsu Masayuki Furutake Bunsei Nobukawa Koichi Suda Department of Internal Medicine Saku Central Hospital Nagano 384-0301 Japan Department of Surgery Saku Central Hospital Nagano 384-0301 Japan Department of Clinical Pathology Saku Central Hospital Nagano 384-0301 Japan Department of Human Pathology Juntendo University School of Medicine Tokyo Japan Department of Pathology Tokyo-West Tokusyukai Hospital Tokyo Japan

This report describes serial observations of the growth process of a small invasive ductal carcinoma (IDC) of the pancreas from imaging studies. Histopathological studies showed IDC with macroscopic retention cysts proximal to an intraductal papillary-mucinous adenoma with mild atypia of the branch duct type in the pancreatic body, with no relation between the two lesions. IDC was demonstrated as an extremely low-echoic mass resembling a cyst with an unclear margin on the initial endoscopic ultrasonography. We misinterpreted the low-echoic mass as a benign intraductal mucinous-papillary neoplasm (IPMN) based on findings of other imaging studies, and the patient was followed-up. The mass increased from 7 mm to 13 mm in diameter over 22 mo, and remained smaller than 10 mm in diameter for about 420 d. The tumor volume doubling time was 252 d. The Ki67 labeling index was 15.9%, similar to that described in previous reports. Hence, IDC may grow slowly while remaining small.

关键词： Invasive ductal carcinoma Pancreas intraductal papillary-mucinous neoplasm Endoscopicultrasonography Tumor volume doubling time

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