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首页> 外文期刊>International Journal of Surgery Case Reports >Pancreas-sparing and superior mesenteric artery first approach in duodenal adenocarcinoma of the fourth portion of duodenum: A case report
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Pancreas-sparing and superior mesenteric artery first approach in duodenal adenocarcinoma of the fourth portion of duodenum: A case report

机译：十二指肠第四部分十二指肠腺癌的保胰和肠系膜上动脉优先入路：一例报告

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Introduction Peroperative assessment of resectability in pancreas-sparing duodenectomy for distal duodenal (D3-D4) adenocarcinoma is challenging for surgeons. Presentation of case 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. Discussion 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%. Conclusion 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.
机译：简介保留胰十二指肠切除术治疗远端十二指肠腺（D3-D4）腺癌的可切除性对外科医师而言是一项挑战。病例介绍我们报告了一名68岁的男性，经活检证实为十二指肠第四部分的腺癌，已通过上内镜和CT诊断。使用肠系膜上动脉先行胰腺保留十二指肠切除术并进行局部区域淋巴结切除术。讨论十二指肠第四部分的腺癌很少见。它具有非特异性症状。诊断困难并且经常延迟。手术是治愈的唯一机会。在对手术的可切除性进行术前评估后，应术中超声检查，使用动脉优先方法对十二指肠完全暴露并彻底分离肠系膜上动脉（SMA），以评估肿瘤的可切除性，其中应包括完全淋巴结清扫术的可能性。肠系膜的根如果技术上可行，应首选保留胰腺的切除术，以避免胰腺切除术相关的病死率。手术的目的是R0切除，其5年生存率在25％到75％之间。结论十二指肠远端腺癌的外科医生应考虑采用SMA的动脉优先方法，以发现任何禁忌症，以进一步进行手术。

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