微小な十二指腸カルチノイドの術後再発例の1切除経験  [in Japanese] A RESECTED CASE OF RECURRENT MINUTE CARCINOID OF THE DUODENUM AFTER OPERATION  [in Japanese]

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Abstract

症例は, 44歳女性.平成5年に十二指腸下行脚の微小なカルチノイド(5mm, sm)で,十二指腸の部分切除術を施行した.以後外来で経過観察を行っていたが,平成9年1月に十二指腸の乳頭部より約1cm口側に山田2型のポリープを認め,生検にてカルチノイドの診断をえたため,再発と診断し手術目的にて外科入院となる.手術所見では,約2cm大の境界不明瞭な硬結が膵頭部まで浸潤しており,膵頭十二指腸切除術を施行した.<br> 一般に十二指腸のカルチノイドは, 20mm未満でsm以下であれば局所切除の適応とされているが,われわれの症例では5mmで深達度smで局所切除を施行した後に再発しており,非常に稀な症例であると考えた.この様な症例では局所切除の適応であると判断するが,術前の浸潤性の検索,術中のリンパ節の検索,術後の経過観察が重要であると考えられた.

This paper report a case of recurrent minute carcinoid of the duodenum after operation in a 44-year-old woman. The patient had undergone a partial resction of the duodenum for minute carcinoid (5mm in size, sm) in the descending part of the duodenum in 1993, and then was followed up in the outpatient clinic. In January, 1997, she was found having a Yamada's type 2 tumor about 1cm oral from the duodenal papilla. With a biopsy, carcinoid was diagnosed. The patient was admitted to the hospital for operation with a diagnosis of recurrence of duodenal carcinoid. At operation, an ill-defined indulation about 2cm in size infiltrating into the pancreatic head was seen, and a pancreatico duodenectomy was performed.<br> In general, carcinoids of the duodenum which are less than 20mm in size and submucosal or shallower in tumor invasion are indicated local resection. In our case, however, despite the primary duodenal tumor was 5mm in size with the depth of tumor invasion of sm which fulfilled the conditions, the recurrece had occurred after operation, that was thought very rare. We decide that local resection can be indicated for minute carcinoids, but preoperative close examination of the depth of tumor invasion, intraoperative exploration of lymph nodes, and postoperative clinical observation may be important.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 61(2), 395-399, 2000-02-25

    Japan Surgical Association

References:  8

Cited by:  6

Codes

  • NII Article ID (NAID)
    10008501898
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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