Abstract：
A 31-year-old man with a big epigastric mass from pancreas body was completely removed by distal pancreatectomy and segmental gastrectomy. Two years after oral administration of S-1 for 4 courses, peritoneal dissemination on the right subdiaphragmatic space was detected. Laparotomy revealed white colored round nodules were found scattered on the peritoneal surface, and the peritoneal cancer index(PCI)was 18. To achieve complete resection of peritoneal nodules, peritonectomy was performed. After complete removal of macroscopic peritoneal metastasis(PM), intraoperative hyperthermic intraoperative peritoneal chemotherapy using 1 gr of gemcitabine and 60 mg of docetaxel was performed for 40 min with thermal dose of 41.5 min. Postoperative course was uneventful. Drug sensitivity test(HDRA method)showed that gemcitabine that gemcitabine showed the highest inhibition rate. The patient was treated with systemic gemcitabine chemotherapy. He is still alive without recurrence 18 months after peritonectomy plus intraoperative HIPEC. Pathological examination showed pancreatic acinar cell carcinoma(PACC)demonstrating positive for chymotrypsin. In conclusion, we present a PACC-case with PM successfully treated by a comprehensive treatment. Intraoperative HIPEC using gemcitabine may be effective for PACC patients with PM in treating residual micrometastasis after peritonectomy.
摘要：
通过远端胰腺切除术和节段性胃切除术完全切除了一名31岁的男子，该男子的上腹部肿块很大。口服S-14疗程后两年，检测到右侧膈下空间的腹膜播散。剖腹显示腹膜表面可见白色圆形结节，腹膜癌指数(PCI)为18。为了实现腹膜结节的完整切除，进行了子宫内膜切除术。彻底切除宏观腹膜转移（PM）后，术中使用1gr吉西他滨和60mg多西他赛进行术中腹腔热化疗40分钟，热剂量为41.5分钟。术后病程顺利。药敏试验(HDRA法)显示，吉西他滨显示出最高的抑瘤率。患者接受全身吉西他滨化疗。他仍然活着，在腹膜炎切除术加术中HIPEC后18个月没有复发。病理检查显示胰腺腺泡细胞癌（PACC）显示胰凝乳蛋白酶阳性。总之,我们介绍1例PACC合并PM的综合治疗成功。术中使用吉西他滨的HIPEC可能对患有PM的PACC患者治疗腹膜切除术后残留的微转移有效。
