臨床外科73巻3号

2018年03月発行

特集 徹底解説！—膵頭十二指腸切除の手術手技 総論

切除・再建術式の種類と特徴

著者： 川井学¹ 山上裕機¹

所属機関： ¹和歌山県立医科大学第2外科

ページ範囲：P.274 - P.278

【ポイント】
◆膵頭十二指腸切除の切除方法には，①膵頭十二指腸切除，②幽門輪温存膵頭十二指腸切除，③亜全胃温存膵頭十二指腸切除がある．
◆膵頭部癌における膵頭十二指腸切除において，幽門輪切除に対して幽門輪温存あるいは亜全胃温存による生存率の低下はなく，手術根治度も同等である．
◆膵頭十二指腸切除後の再建方法は，①Ⅰ型（胆管，膵，胃の順に吻合），②Ⅱ型（膵，胆管，胃の順に吻合），③Ⅲ型（ⓐ胃，膵，胆管，あるいはⓑ胃，胆管，膵の順に吻合），④Ⅳ型（その他の吻合）に分類される．

参考文献

1）日本膵臓学会（編）：膵癌取扱い規約，第7版．金原出版，2016

2）Lin PW, Lin YJ：Prospective randomized comparison between pylorus preserving and standard pancreaticoduodenectomy. Br J Surg 86：603-607, 1999

3）Seiler CA, Wagner M, Sadowski C, et al：Randomized prospective trial of pylorus-preserving vs classic duodenopancreatectomy（Whipple procedure）：initial clinical results. J Gastrointest Surg 4：443-452, 2000

4）Tran KT, Smeenk HG, van Eijck CH, et al：Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure. A prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 240：738-745, 2004

5）Seiler CA, Wagner M, Bachmann CA, et al：Randomized clinical trial of pylorus-preserving duodenopancreatectomy versus classical Whipple resection-long term results. Br J Surg 92：547-556, 2005

6）Lin PW, Shan YS, Lin YJ, et al：Pancreaticoduodenectomy for pancreatic head cancer：PPPD versus Whipple procedure. Hepatogastroenterology 52：1601-1604, 2005

7）日本膵臓学会（編）：科学的根拠に基づく膵癌診療ガイドライン2016年版．金原出版，2016

8）Kawai M, Tani M, Hirono S, et al：Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy：a prospective randomized controlled trial of pylorus-resecting versus pylorus-preserving pancreatoduodenectomy. Ann Surg 253：495-501, 2011

9）Kurahara H, Takao S, Shinchi H, et al：Subtotal stomach-preserving pancreaticoduodenectomy（SSPPD）prevents postoperative delayed gastric emptying. J Surg Oncol 102：615-619, 2010

10）Fujii T, Kanda M, Kodera Y, et al：Preservation of the pyloric ring has little value in surgery for pancreatic head cancer：a comparative study comparing three surgical procedures. Ann Surg Oncol 19：176-183, 2012

11）Nanashima A, Abo T, Sumida Y, et al：Comparison of results between pylorus-preserving pancreaticoduodenectomy and subtotal stomach-preserving pancreaticoduodenectomy：report at a single cancer institute. Hepatogastroenterology 60：1182-1188, 2013

12）Hackert T, Hinz U, Hartwig W, et al：Pylorus resection in partial pancreaticoduodenectomy：impact on delayed gastric emptying. Am J Surg 206：296-299, 2013

13）Matsumoto I, Shinzeki M, Asari S, et al：A prospective randomized comparison between pylorus- and subtotal stomach-preserving pancreatoduodenectomy on postoperative delayed gastric emptying occurrence and long-term nutritional status. J Surg Oncol 109：690-696, 2014

14）Hanna MM, Gadde R, Tamariz L, et al：Delayed gastric emptying after pancreaticoduodenectomy：is subtotal stomach preserving better or pylorus preserving? J Gastrointest Surg 19：1542-1552, 2015

15）Tani M, Kawai M, Terasawa H, et al：Complications with reconstruction procedures in pylorus-preserving pancreaticoduodenectomy. World J Surg 29：881-884, 2005

16）Tani M, Kawai M, Hirono S, et al：Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancreaticoduodenectomy. Br J Surg 101：1084-1091, 2014