内容紹介
Summary
A 46-year-old woman with epigastric pain was found to have a tumor of the pancreatic head. Computed tomography(CT)revealed a plethoric and poorly-marginated, 7 cm tumor in the pancreatic head. The superior mesenteric vein(SMV)was infiltrated from the duodenal inferior margin and a 6 cm occlusion extended to the merger with the splenic vein. Diagnostic criteria identified locally advanced pancreatic cancer(UR-P)with a limitation in portal reconstruction. Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)diagnosed mixed acinar-endocrine carcinoma(MAEC). Due to rarity, a chemotherapy protocol has not been established. Thus, the first option for treatment was resection. CT showed that the required graft was 7 cm in length, with SMV 0.5 cm in diameter at the intestinal side and 1.4 cm in diameter at the hepatic side; accordingly, the superficial femoral vein(SFV)was selected for use. Compared to the external iliac vein, the graft is slightly thinner and about 10 cm can be harvested. This graft is useful for cases that require reconstruction of the distal SMV.
要旨
症例は46歳,女性。心窩部痛精査にて膵頭部腫瘤を指摘され受診した。CTにて膵頭部を占拠する7 cm大の多血性,境界不明瞭な腫瘍を認めた。上腸間膜静脈(SMV)は,十二指腸下縁レベルから浸潤を受け,脾静脈合流部まで6 cm閉塞し,規約上は門脈再建限界の局所進行膵癌(UR-P)であった。EUS-FNAでmixed acinar-endocrine carcinoma(MAEC)の診断を得たがまれであり,化学療法が定まってないため切除先行の方針とした。CT上,必要なグラフトサイズは長さ7cm,腸側SMV径0.5 cm,肝側SMV径1.4 cmであり,浅大腿静脈(SFV)を選択した。外腸骨静脈に比べて若干細く,10 cm程度採取可能である。SMV末【梢】での再建が必要な症例には有用である。
目次
A 46-year-old woman with epigastric pain was found to have a tumor of the pancreatic head. Computed tomography(CT)revealed a plethoric and poorly-marginated, 7 cm tumor in the pancreatic head. The superior mesenteric vein(SMV)was infiltrated from the duodenal inferior margin and a 6 cm occlusion extended to the merger with the splenic vein. Diagnostic criteria identified locally advanced pancreatic cancer(UR-P)with a limitation in portal reconstruction. Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)diagnosed mixed acinar-endocrine carcinoma(MAEC). Due to rarity, a chemotherapy protocol has not been established. Thus, the first option for treatment was resection. CT showed that the required graft was 7 cm in length, with SMV 0.5 cm in diameter at the intestinal side and 1.4 cm in diameter at the hepatic side; accordingly, the superficial femoral vein(SFV)was selected for use. Compared to the external iliac vein, the graft is slightly thinner and about 10 cm can be harvested. This graft is useful for cases that require reconstruction of the distal SMV.
要旨
症例は46歳,女性。心窩部痛精査にて膵頭部腫瘤を指摘され受診した。CTにて膵頭部を占拠する7 cm大の多血性,境界不明瞭な腫瘍を認めた。上腸間膜静脈(SMV)は,十二指腸下縁レベルから浸潤を受け,脾静脈合流部まで6 cm閉塞し,規約上は門脈再建限界の局所進行膵癌(UR-P)であった。EUS-FNAでmixed acinar-endocrine carcinoma(MAEC)の診断を得たがまれであり,化学療法が定まってないため切除先行の方針とした。CT上,必要なグラフトサイズは長さ7cm,腸側SMV径0.5 cm,肝側SMV径1.4 cmであり,浅大腿静脈(SFV)を選択した。外腸骨静脈に比べて若干細く,10 cm程度採取可能である。SMV末【梢】での再建が必要な症例には有用である。