背景:对于外科医师而言,保留胰腺的十二指肠切除术治疗十二指肠远端(D3-D4)腺癌的可切除性评估具有挑战性。
方法:我们报告了一名68岁的男子,经活检证实为十二指肠第四部分腺癌,经上消化道内镜和CT检查确诊。使用肠系膜上动脉先入路进行了保留胰腺的十二指肠切除术和局部区域淋巴结切除术。
结论:十二指肠第四部分的腺癌是罕见的。它具有非特异性症状。诊断困难且经常延迟。手术是治愈的唯一机会。围手术期可切除性评估后,术中超声检查,应使用动脉优先入路技术对十二指肠和肠系膜上动脉(SMA)进行完全剥离,以评估肿瘤的可切除性,其中应包括肠系膜根部完整淋巴结清扫术的可能性。如果技术上可行,应首选保留胰腺的切除术,以避免胰腺切除术相关的死亡率.手术的目的是R0切除,5年生存率在25%至75%之间。
结论:在十二指肠远端腺癌中,外科医生应考虑动脉先入路的SMA,以确定任何禁忌症,以进一步进行。
BACKGROUND: Peroperative assessment of resectability in pancreas-sparing duodenectomy for distal duodenal (D3-D4) adenocarcinoma is challenging for surgeons.
METHODS: We report a 68-year-old man with biopsy-proven adenocarcinoma of the fourth portion of duodenum which had been diagnosed with upper endoscopy and CT. A pancreas-sparing duodenectomy with loco-regional lymph node resection using the superior mesenteric artery first approach was performed.
CONCLUSIONS: Adenocarcinoma of the fourth portion of duodenum is rare. It has non-specific symptoms. The diagnosis is difficult and is frequently delayed. Surgery is the only chance of cure. After peroperative assessment of resectability, with intraoperative ultrasound, complete exposition of the duodenum and entire dissection of the superior mesenteric artery (SMA) using the artery-first approach technique should be done to assess for tumor resectability, which should include the possibility of complete lymphadenectomy of the mesenteric root. If technically feasible, a pancreas-sparing resection should be preferred to avoid pancreatectomy-related morbi-mortality. The aim of the surgery is a R0 resection which has a 5-year survival rate between 25% and 75%.
CONCLUSIONS: Artery-first approach of the SMA should be considered by surgeons in adenocarcinoma of the distal duodenum to identify any contra-indications to proceed further.