胰十二指肠切除术后晚期胰瘘1例报告及文献复习。

Case reports in pancreatic cancer Pub Date : 2016-11-01 eCollection Date: 2016-01-01 DOI:10.1089/crpc.2016.0015
Numa P Perez, David G Forcione, Cristina R Ferrone
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引用次数: 1

摘要

背景:胰十二指肠切除术(PD)在提出100多年后仍然是一项具有挑战性的手术,其发病率很高,通常是由于术后胰瘘(POPF)。与患者生理、肿瘤解剖/病理和外科医生/手术技术相关的因素已被研究,产生的结果有时相互矛盾且难以重现。我们提出了一个病例的晚期POPF以及简要回顾当前的文献。病例介绍:患者为55岁女性,吸烟史20包年,无酗酒史,因新发恶心就诊。她的实验室检查和计算机断层扫描(CT)显示胆道梗阻。她被发现患有侵袭性壶腹腺癌,随后接受了典型的PD。她发展了POPF,通过术中放置的封闭吸引引流管进行管理。她的病程因腹内脓肿的发展而变得复杂,通过ct引导下经皮放置两根引流管进行治疗,随后无问题切除。术后8个月,患者出现腹痛和胰腺炎。她被发现有腹腔内收集,再次经皮通过ct引导引流。这一次,引流液中淀粉酶和脂肪酶的水平分别为21,860和86,650 U/L,培养无菌。经胰瘘检查,发现胰空肠吻合术处有严重狭窄。她接受了内镜下放置的霍布斯支架由胃肠道服务。结论:虽然通常在PD后的几天到几周内诊断出来,但我们提出了一个在首次手术后8个月出现POPF并伴有PJ狭窄的病例。本病例强调了在出现胰腺炎症状和/或影像学结果与腹腔内收集一致的患者手术数月后考虑诊断的重要性。
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Late Pancreatic Fistula After Pancreaticoduodenectomy: A Case Report and Review of the Literature.

Background: More than 100 years after its conception, the pancreaticoduodenectomy (PD) remains a challenging procedure with significant morbidity, often due to a postoperative pancreatic fistula (POPF). Factors related to patient physiology, tumor anatomy/pathology, and surgeon/surgical technique have been studied, yielding results at times conflicting and difficult to reproduce. We present a case of a late POPF along with a brief review of the current literature. Case Presentation: The patient is a 55-year-old female with a 20 pack-year smoking history and no history of alcohol abuse, who presented for evaluation of new nausea. Her laboratory tests and computed tomography (CT) imaging were suggestive of biliary obstruction. She was found to have an invasive ampullary adenocarcinoma and subsequently underwent a classic PD. She developed a POPF, managed through a closed suction drain placed intraoperatively. Her course was complicated by the development of an intra-abdominal abscess, managed percutaneously through CT-guided placement of two drains, subsequently removed without issues. She recovered uneventfully until 8 months after the operation, when she presented with abdominal pain and pancreatitis. She was found to have an intra-abdominal collection, again managed percutaneously via CT-guided drainage. This time, the amylase and lipase levels of the drainage fluid were 21,860 and 86,650 U/L, respectively, and cultures were sterile. Upon workup of her pancreatic fistula, a severe stricture at the pancreaticojejunostomy (PJ) was identified. She underwent endoscopic placement of a Hobbs stent by the GI service. Conclusion: Although commonly diagnosed in the days to weeks after a PD, we present a case of a POPF that manifested 8 months after the initial operation in association with a PJ stricture. This case highlights the importance of considering the diagnosis even months after the operation in a patient who presents with symptoms of pancreatitis and/or imaging findings consistent with an intra-abdominal collection.

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