Total stomach-preserving duodenojejunostomy for unresectable cancer of the head of the pancreas

症例は50歳代の男性で,黄疸を契機に膵癌と診断された.外科的根治切除を目的に開腹したが,術中迅速病理組織検査で傍大動脈リンパ節に転移を認め,非切除となった.そこで総胆管空腸吻合とともに,QOLの維持及び通過障害の予防を目的とした,十二指腸離断を伴う全胃温存十二指腸空腸吻合を行った.その後外来化学療法を行いながら社会復帰を果たし,腫瘍増大は認めたものの黄疸や通過障害を来すことなく,術後2年5ヵ月の生存を得た.切除不能膵頭部癌に対する十二指腸離断を伴う全胃温存十二指腸空腸吻合は,病変部からバイパス路を十分に離すことで腫瘍進展に伴う狭窄を回避することが出来,また全胃温存効果により消化吸収機能の温存と栄養状態の維持を可能とする,有用な術式ではないかと考えられた.

A man in his fifties presenting with jaundice was admitted to our hospital. A detailed examination revealed cancer of the head of the pancreas. While performing a laparotomy, the tumor was found to be unresectable because of metastasis to the para-aortic lymph nodes. Therefore, a choledochojejunostomy and total stomach-preserving duodenojejunostomy were performed. The duodenojejunostomy was performed distal to the jejunojejunostomy so that it was some distance away from the tumor. After surgery, the patient made a good, functional recovery and subsequently survived for 2 years and 5 months with the aid of chemotherapy. Total stomach-preserving duodenojejunostomy may be a useful method of palliative surgery for the treatment of unresectable cancer of the head of the pancreas, because it enables the maintenance of adequate oral intake for a longer period compared with that with a gastrojejunostomy, even in the presence of tumor enlargement or invasion.

切除不能膵頭部癌

十二指腸空腸吻合術

緩和手術