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台灣胰臟醫學會 106 年度春季醫學病例研討會

會 議 議 程

時間：106 年 4 月 15 日 (星期六) 下午 13:35 至 17:30

地點：台北榮民總醫院中正樓十樓一般外科會議室 (地址：台北市北投區石牌路二段 201 號)

主辦單位：台灣胰臟醫學會、台北榮民總醫院一般外科、振興醫院一般外科

協辦單位：台灣東洋藥品工業股份有限公司

報到時間：13:00~ (不收費)

13:30~13:35 致 詞 台灣胰臟醫學會 李嘉龍 理事長

台北榮民總醫院一般外科 石宜銘 主任

時 間 題 目 報 告 者

座 長：邱正堂 醫師 / 王心儀 醫師

CASE I：

13:35~14:00

14:00~14:10

病例報告

綜合討論

宋明璋 醫師 / 蘇正熙 醫師

振興醫院一般外科

CASE II：

14:10~14:35

14:35~14:45

病例報告

綜合討論

宋明璋 醫師 / 蘇正熙 醫師

振興醫院一般外科

CASE III：

14:45~15:10

15:10~15:20

病例報告

綜合討論

郭家旗 醫師 / 廖偉智 醫師

台大醫院胃腸肝膽科

15:20~15:40 Coffee Break

座 長：石宜銘 醫師

15:40~16:10 [專題演講]

Surgical Implications of Neoadjuvant Therapy for

Pancreatic Cancer

田郁文 醫師

台大醫院一般外科 16:10~16:20 綜合討論

座 長：王秀伯 醫師 / 沈延盛 醫師

CASE IV：

16:20~16:45

16:45~16:55

病例報告

綜合討論

陳世欽 醫師 / 石宜銘 醫師

台北榮總一般外科

CASE V：

16:55~17:20

17:20~17:30

病例報告

綜合討論

張學豪 醫師 / 王鐘貴 醫師

台北市立聯合醫院仁愛院區消化內科

18:00 台灣胰臟醫學會第六屆第五次理事監事聯席會

學會教育積分：(申請中)

台灣外科醫學會 台灣內科醫學會

台灣消化系外科醫學會 台灣消化系內視鏡醫學會

台灣消化系醫學會 中華民國醫用超音波醫學會

中華民國放射線醫學會 中華民國癌症醫學會

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◎ 交通資訊：停車半價優惠 (請至報到櫃台索取優惠卡)

開車路線：

國道一號 (中山高 )→由重慶北路交流道下 (往士林方向 )，過百齡橋→(左轉 )承德路五、

六段→(右轉 )石牌路一段→石牌路二段 201 號 (台北榮民總醫院 )

大眾運輸：

公車：216,223,224,266,267,277,285,288,290,508,601,606,646,105,紅 12,紅 19, 645,902 (站名：台北榮總)

捷運淡水線：石牌站 (本院專車接送)

北榮轉乘服務車 (台北榮總(中正樓)←→捷運石牌站)：上午：7：00~18：00(每 10 分鐘乙班)

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報告者簡歷

中文姓名 宋明璋

英文姓名 Ming-Zhang Song

性別 男

連絡電話 0985094634

電子信箱 b9005015@gmail.com

學歷 長庚大學中西醫學系

經歷 2010.07~2012.11 振興醫院外科部住院醫師

2012.11~2014.07 振興醫院一般外科住院醫師

2014.07~2015.07 振興醫院一般外科總醫師

2015.07~2016.08 振興醫院一般外科資深住院醫師

2016.9~ 振興醫院急診醫學部兼一般外科主治

醫師

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宋明璋 醫師

振興醫院 急診醫學部兼一般外科

病例摘要:

【Case 1】

Abstract:

Acinar cell cystadenoma of pancreas is a very rare pancreatic cystic lesion. It is also a benign

lesion without malignant potential. Because it is normal tissue with abnormal figuration,

acinar cell transformation is also named. We reported a 37-year-old female noticed to have a

cystic lesion closely in contact with the pancreatic tail by abdominal CT scan. After operation,

the cystic lesion was analyzed and acinar cell cystadenoma arising from retroperitoneum was

confirmed. Literature review revealed only one case of retroperitoneal acinar cell

cystadenoma was reported before and the pathogenesis is still unknown.

【Case 2】

Abstract:

Splenic vein aneurysms are rare. The first case of a splenic vein aneurysm was reported by

Loewenthal and Jacob in 1953. Most splenic vein aneurysms are asymptomatic and are

usually incidental findings. We reported a 65-year-old male presented with intermittent lower

back pain and painless hematuria for 2 months. CT scan revealed an incidental finding of

pancreatic tail tumor with contrast enhancement. A splenic vein aneurysm was diagnosed by

pathology after hemi-pancreatectomy and splenectomy. The possible etiology of splenic vein

aneurysm were portal hypertension and congenital weakness in the vein wall. Due to no

relative history on the patient, a congenital splenic vein aneurysm was favored. Surgical

intervention can be considered if there are symptoms or complications.

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CURRICULUM VITAE of Chia-Chi Kuo

Name: Chia-Chi Kuo (郭家旗)

Nationality: Taiwan, Republic of China（R.O.C.）

Affiliation： Attending physician, Division of Hepatology &

Gastroenterology

Department of Internal Medicine

National Taiwan University, Yun-Lin Branch, Yunlin, Taiwan

Address： Department of Internal Medicine

National Taiwan University, Yun-Lin Branch, Yunlin, Taiwan

No.579,sec2, Yulin Rd, Douliou City,Yulin Country

640,Taiwan

Education：

2003-2010 College of Medicine, National Taiwan University, Taipei,

Taiwan

Training and academic appointment：

2016~ Attending physician, Division of Hepatology &

Gastroenterology

Department of Internal Medicine

National Taiwan University, Yun-Lin Branch, Yunlin, Taiwan

2016 Trainee, Center for Gastroenterology, Tokyo University

Hospital, Tokyo, Japan

2014-2016 Chief Resident, Research Fellow in Gastroenterology,

Department of Internal Medicine, National Taiwan University

Hospital, Taipei, Taiwan

2011-2014 Resident, Department of Internal Medicine, National Taiwan

University Hospital, Taipei, Taiwan

2009-2010 Intern (Medicine), National Taiwan University Hospital,

Taipei, Taiwan

Board certification:

January, 2017 Chinese Board of Gastroenterology

October, 2014 Chinese Board of Internal Medicine

September, 2010 Chinese Board of Physician

Membership and appointments:

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2017 - Member, Taiwan Society of Gastroenterology

2014 - Member, Taiwan Society of Internal Medicine.

Publication List: Nil

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郭家旗 醫師

台大醫院 胃腸肝膽科

病例摘要:

This is a 78-year-old man with history of COPD followed up at chest OPD.

He was diagnosed as autoimmune pancreatitis according to abdominal echo, CT (decreased

enhancement of p-body & tail) and elevated IgG4 level since 2012/7. The CA 19-9 was

mildly elevated. Oral predonine 30mg/day was prescribed. During GI OPD follow up, the

IgG4 level fluctuated but no abdominal symptoms was noted. However, progressive elevation

of CA199/CEA was noted although abdominal echo showed stationary pancreatic tail

hypo-echogenicity. PET showed multiple uptake pancreatic mass. FNA was performed on

2016/5/17. Cytology showed few clusters of atypical ductal epithelial cells are present in the

mucoid background, and histology showed mucin-producing epithelial cells with low grade

dysplasia. Intraductal papillary mucinous neoplasm was favored first but not diagnostic.

Operation was suggested but the patient hesitated. Elevated CA19-9 to 408.17 U/ml was

noted on 2016/11/1. Abdominal echo showed hypoic change of body & tail with dilated MPD

(5.1 mm). Abdominal CT showed a 4cm hypoenhancing mass at pancreatic body, with

upstream parenchymal atrophy. The size of pancreatic body mass increased. He then received

distal pancrectomy at VGH Taipei on 2017/1/5. Pathology staging was pT3N1, lymphatic &

perineural infiltration (+/+), LN (3+/31). Final diagnosis was pancreatic adenocarcinoma,

pT3N1M0, stage IIIB, s/p distal pancrectomy (2017/1/5), margin free, LN (3+/31). Adjuvant

TS-1 was started at oncology OPD since 2017/3/1.

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姓名: 田郁文

出生日期: l959-01-26

學歷:

1997/08 - 2001/03 台灣大學醫學院臨床醫學研究所博士.

學士後訓練：:

1987/08 - 1992/07 台大醫院外科住院醫師

1999/07 - 2000/06 美國國家移植中心研究員.

專長：:

胰臟外科、胰臟移植

醫院任職:

1992/07 – l996/09 新光醫院外科主治醫師。

1997/10 – now 台大醫院外科主治醫師。

2011/08– now 台大醫院胰內分泌外科主任。

2012/08-now 臺大醫院胰臟腫瘤多科治療團隊召集人。

學術任職:

2004/08 –2007/07 台大醫學院外科助理教授

2007/08 – 2011/07 台大醫學院外科副教授

2011/08-now 台大醫學院外科教授

主要研究興趣：

1. 癌症轉移機制

2. 胰臟腫瘤.

3. 胰臟手術

Publication lists:

1. Yu-Wen Tien, King-Jen Chang*, Yung-Ming Jeng, Po-Huang Lee, Ming-Shi Wu, Jaw-Town Lin,

Su-Ming Hsu. Tumor Angiogenesis and Its Possible Role in Intravasation of Colorectal Epithelial.

Clin Cancer Res 2001; 7:1627-1632.

2. Jin-De Chen, Ming-Shiang Wu, Yu-Wen Tien, Kuang-Ting Kuo, Ming-Chu Chang, Jaw-Town Lin.

Acinar cell carcinoma with hypervascularity. J Gastroenterol & Hepatol. 2001; 16: 107-11.

3. Ming-Chu Chang, Yu-Ting Chang, Ming-Shiang Wu, Chia-Tung Shun, Yu-Wen Tien, Jaw-Town Lin.

K-ras Mutation at Codon 12 in Stage I Pancreatic Adenocarcinoma: Analysis by Laser Capture

Microdissection and Direct Sequencing. J Formos Med Assoc 2001;100: 352-354.

4. Yu-Wen Tien, Po-Huang Lee, Shih-Ming Wang, Su-Ming Hsu, King-Jen Chang*. Simultaneous

Detection of Colonic Epithelial Cells in Portal Venous and Peripheral Blood. Dis Colon & Rectum

2002; 45: 23-29.

5. Yu-Wen Tien*, King-Jen Chang. Diffuse pancreatic islet cell disease with hyperinsulinism in adults:

problems in recognition and management. Chinese Med. J.2002; 65: 91-92.

6. Yu-Wen Tien, Po-Huang Lee*, Rey-Heng Hu, Su-Ming Hsu, King-Jen Chang. The Role of

Gelatinase in hepatic metastasis of colorectal cancer. Clin Cancer Res 2003; 9: 4891-6.

9

7. Yu-Wen Tien*, Yung-Ming Jeng, Rey-Heng Hu, Po-Huang Lee, King-Jen Chang.

Intravasation-Reltated metastatic factors in colorectal cancer. Tumor Biology 2004; 25:48-55.

(corresponding author)

8. Yu-Wen Tien*, Hsien-Li Kao, and Hsiu-Po Wang. Celiac Artery Stenting: A New Strategy for

Patients with Pancreaticoduodenal Artery. J. Gastroenterol. 2004;39:81-85. (corresponding author)

9. Chin-Sheng Hung, Peter Lin, Yu-Wen Tien*, Po-Huang Lee. Duodenum-Preserving pancreatic head

resection: Preliminary report on indications and techniques Formos J. Surg. 2004; 37:254-260.

(corresponding author)

10. Yu-Min Huang, Haw-Tzong Chen, Yao-Jen Chang, Yu-Wen Tien*. Huge Periampullary Tumors

Simulating Hepatic Hilar Tumors---A Report of Three Cases. Tzu-Chi Med. J 2004; 16: 193-6.

(corresponding author)

11. Yu-Wen Tien*, Kong-Han Ser, , Rey-Heng Hu , Chih-Yuan Lee , Yung-Ming Jeng , Po-Huang Lee.

Solid Pseudopapillary Neoplasms of the Pancreas: is there a pathologic basis for the gender

difference in incidence. Surgery 2005; 137: 591-6. (corresponding author)

12. Yu-Wen Tien*, Po-Huang, Chin-Yao Yang, Ming-Chih Ho, Chen-Feng Chiu. Risk factors of massive

bleeding after pancreatic leak following oancreaticoduodenectomy. J of American College Surgeon

2005, 201:554-9. (corresponding author)

13. Ming-Chu Chang, Yu-Ting Chang, Yu-Wen Tien, Chia-Tung Sun, Ming-Shiang Wu, Jaw-Town Lin.

Distinct chromosomal aberrations of ampulla of vater and pancreatic head cancers detected by laser

capture microdissection and comparative genomic hybridization. Oncology Reports 2005; 14;867-72

14. Yu-Wen Tien*, King-Jen Chang, Yen-Feng Chiu, Kai-Wen Huang, Po-Huang Lee. Comparison of

Angiogenic Factor Levels in Tumor Drainage and Peripheral Venous Blood from Colorectal Cancer

Patients. Ann Surg Oncol, 2006;13:1357-63. (corresponding author)

15. Lee TC. Liu KL. Tien YW. Shun CT. Wang HP. Subserosal bullae in pneumatosis intestinalis.

Surgery 2006;139(6):851-3.

16. Lee TC. Liu KL. Lin JT. Tien YW. Mao TL. Wang HP. An unusual cause of pancreatitis--patient

with dominant dorsal pancreatic duct syndrome and intraductal papillary mucinous neoplasm (IPMN)

in the ventral pancreatic duct. Gut 2006;55(2):164, 171.

17. Ming-Chug Chang , Yu-Ting Chang, Chia-Tung Sun, Yen-Feng Chiu, Jaw-Town Lin, and Yu-Wen

Tien*. Differential expressions of cyclin D1 associated with better prognosis of cancers of ampulla

of Vater. World J Surg 2007;30:1-8. (corresponding author)

18. Chang MC. Chang YT. Tien YW. Liang PC. Wei SC. Wong JM.. Association of tumour necrosis

factor alpha promoter haplotype with chronic pancreatitis. Gut 2006; 55(11):1674-6.

19. Ji-Shiang Hung, Ming-Chu Chang, Po-Huang Lee, Yu-Wen Tien*. Is surgery indicated for patients

with symptomatic nonfunctioning pancreatic neuroendocrine tumor and unresectable hepatic

metastases? World J Surg 2007;30:1-8. (corresponding author)

20. Ji-Shiang Hung, Ching-Yao Yang, Rey-Heng Hu, Po-Huang Lee, Yu-Wen Tien*. Surgical treatment

of pancreatic serous cystadenoma- Aggressive for operations but limited resections. Pancreas 2007,

35:358-360. (corresponding author)

21. Chang MC. Chang YT. Tien YW. Liang PC. Jan IS. Wei SC. Wong JM. T-cell regulatory gene

CTLA-4 polymorphism/haplotype association with autoimmune pancreatitis. Clinic Chem 2007;

53(9):1700-5.

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22. Chang MC. Chang YT. Su TC. Yang WS. Chen CL. Tien YW. Liang PC. Wei SC. Wong JM.

Adiponectin as a potential differential marker to distinguish pancreatic cancer and chronic

pancreatitis. Pancreas 2007;35(1):16-21.

23. Chang MC. Chang YT. Wei SC. Tien YW. Liang PC. Jan IS. Su YN. Wong JM. Spectrum of

mutations and variants/haplotypes of CFTR and genotype-phenotype correlation in idiopathic

chronic pancreatitis and controls in Chinese by complete analysis. Clinical Genetics.

2007;71(6):530-9.

24. Yu-Wen Tien*, Rey-Heng Hu, Ji-Shiang Hung, Hsui-Po Wang, Po-Huang Lee. Noninvasive

pancreatic cystic neoplasms can be safely and effectively treated by limited pancreatectomy. Ann

Surg Oncol 2008; 15:193-198. (corresponding author)

25. Yu-Wen Tien*, Yao-Ming Wu , Kao-Lang Liu, Cheng-Maw Ho, Po-Huang Lee. Angiography is

indicated for every sentinel Bleed. Ann Surg Oncol 2008; 15: 1855-1861. (corresponding author)

26. Chang YT, Chang MC, Wei SC, Tien YW, Hsu C, Liang PC, Tsao PN, Jan IS. Wong JM. Serum

vascular endothelial growth factor/soluble vascular endothelial growth factor receptor 1 ratio is an

independent prognostic marker in pancreatic cancer. Pancreas 2008; 37:145-150.

27. Liu KL. Teng YC. Tien YW. Lin JT. Elevated alpha-fetoprotein and a pancreatic tumour. Gut

2008;57:434.

28. Chen BB, Tien YW, Lin JT, Liu KL. Image of the month. Ectopic spleen in the pancreatic tail. Arch

Surg 2008;143:205-206.

29. Yu-Wen Tien*, Ching-Yao Yang, Yao-Ming Wu, Rey-Heng Hu, Po-Huang Lee. Enteral Nutrition

and Biliopancreatic Diversion Effectively Minimize Impacts of Gastroparesis after

Pancreaticoduodenectomy. J Gastrointest Surg 2009; 13: 929-937. (corresponding author)

30. Yu-Wen Tien*, Yao-Ming Wu1, Wei-Chou Lin, Hsuan –Shu Lee, Po-Huang Lee. Pancreatic

carcinoma cells stimulate proliferation and matrix synthesis of hepatic stellate cells. J Hepatology

200;51:307-14. (corresponding author)

31. Yu-Wen Tien*, Chi-Chuan Yeh, Shi-Po Wang, Rey-Heng Hu, Po-Huang Lee. Is Blind

Pancreaticoduodenectomy Justified for Patients With Ampullary Neoplsms? J Gastrointest Surg 2009;

13: 929-937. (corresponding author)

32. Yu-Wen Tien*, Chih-Yuan Lee, Chun-Chieh Huang Rey-Heng Hu, Po-Huang Lee. Surgery for

gastrointestinal stroma tumor of the duodenum. Ann Surg Oncol 2010;17:109-114. (corresponding

author)

33. Yu-Wen Tien*, Kao-Lang Liu, Rey-Heng Hu, Hsiu-Po Wang, King-Jen Chang, Po-Huang Lee. Risk

of varices bleeding after spleen-preserving distal pancreatectomy with excision of splenic vessels.

Ann Surg Oncol 2010, 17:2193-2198. (corresponding author)

34. Chi-Chuan Yeh, Yung-Ming Jeng, Cheng-Maw Ho, Rey-Heng Hu, Hsiu-Pi Chang, Yu-Wen Tien*.

Survival after pancreaticoduopdenectomy is not affected by age. World J Surg 2010, 34:2945-2952.

(corresponding author)

35. Jin-Ming Wu, Meng-Kun Tsai, Rey-Heng Hu, Kin-Jen Chang, Po-Huang Lee, Yu-Wen Tien*. Reflux

Esophagitis and Marginal Ulcer after Pancreaticoduodenectomy. J Gastrointest Surg 2011, 15

(5):824-828. (corresponding author)

36. Yang SH. Kuo YH. Tien YW. Hsu C. Hsu CH. Kuo SH. Cheng AL. Inferior survival of advanced

pancreatic cancer patients who received gemcitabine-based chemotherapy but did not participate in

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clinical trials. Oncology 2011;81(3-4):143-50.

37. Ch'ang HJ. Lin YL. Wang HP. Chiu YF. Chang MC. Hsu CH. Tien YW. Chen JS. Hsieh RK. Lin

PW. Shan YS. Cheng AL. Chang JY. Whang-Peng J. Hwang TL. Chen LT. Induction chemotherapy

with gemcitabine, oxaliplatin, and 5-fluorouracil/leucovorin followed by concomitant

chemoradiotherapy in patients with locally advanced pancreatic cancer: a Taiwan cooperative

oncology group phase II study. International Journal of Radiation Oncology, Biology, Physics 2011;

81(5):e749-57.

38. Chen CC. Lin MT. Tien YW. Yen CJ. Huang GH. Inouye SK. Modified hospital elder life program:

effects on abdominal surgery patients. Journal of the American College of Surgeons 2011;

213(2):245-52.

39. Wu JM. Tsai MS. Lin MT. Tien YW. Lin TH. High APACHE II score and long length of bowel

resection impair the outcomes in patients with necrotic bowel induced hepatic portal venous gas.

BMC Gastroenterology 2011; 11:18.

40. Jin-Ming Wu, Ting-Chun Kuo, Ching-Yao Yang, Pin-Yi Chiang, Yung-Ming Jeng, Pei-Hsin Huang,

Yu-Wen Tien*. Resolution of Diabetes After Pancreaticoduodenectomy in Patients with and without

Pancreatic Ductal Cell Adenocarcinoma. Ann Surg Oncol 2013;20:242-249. (corresponding

author).

41. Ting-Chun Kuo, Ching-Yao Yang, Jin-Ming Wu, Pei-Hsin Huang, Hong-Shiee Lai, Po-Huang Lee,

Yu-Wen Tien*. Peripancreatic Schwannoma. Surgery 2013; 153(4):542-548. (corresponding

author).

42. Te-Wei Ho, Jin-Ming Wu, Ting-Chun Kuo, Ching-Yao Yang, Hong-Shiee Lai, Su-Hua Hsieh, Feipei

Lai, and Yu-Wen Tien. Change of Both Endocrine and Exocrine Insufficiencies After Acute

Pancreatitis in Non-Diabetic Patients A Nationwide Population-Based Study. Medicine 2015; 94

(27): e1123. (corresponding author).

43. Jin-Ming Wu, Te-Wei Ho, Ting-Chun Kuo, Ching-Yao Yang, Hong-Shiee Lai, Pin-Yi Chiang,

Su-Hua Hsieh, Feipei Lai, and Yu-Wen Tien. Glycemic Change After Pancreaticoduodenectomy-- A

Population-Based Study. Medicine 2015; 94 (27):e1109. (corresponding author).

44. Chang, Yu-Ting, Tien, Yu-Wen, Jeng, Yung-Ming, Yang, Ching-Yao, Liang, Po-Chin, Wong,

Jau-Min, Chang, Ming-Chu. Overweight Increases the Risk of Malignancy in patients with

pancreatic mucinous cystic neoplasm. Medicine 2014;94(20):e797.

45. Jin-Ming Wu, Ching-Yao Yang, Ting-Chun Kuo, Hong-Shiee Lai, Pin-Yi Chiang, Su-Hua Hsieh,

Yu-Wen Tien. Distal enteral feeding helps sugar control in pancreatectomized patients. World J

Surg 2015; 39 (11): 2771-2775 (corresponding author).

46. Te-Wei Ho; Jin-Ming Wu; Ching-Yao Yang; Hong-Shiee Lai; Feipei Lai, Yu-Wen Tien*. Total

gastrectomy improves glucose metabolism on gastric cancer patients: a nationwide population-based

study. Surg Obesity and related Dis. 2016;12:635-641. (corresponding author). (IF=3.943;

R/C=13/204, SURGERY)

47. Yu Wen Tien*, Hsun-Chuan Kuo, Be-Ing Ho, Ming-Chu Chang, Yu-Ting Chang, Mei-Fang Cheng,

Huai-Lu Chen, Ting-Yung Liang, Chien-Fang Wang, Chia-Yi Huang, Jin-Yuh Shew, Ying Chih

Chang, Eva YHP Lee, Wen-Hwa Lee. A High Circulating Tumor Cell Count in Portal Vein Predicts

Liver Metastasis from Periampullary or Pancreatic Cancer. Medicine 2016;95:1-7.

12

48. Chih-Yang Hsiao, Ching-Yao Yang, Jin-Ming Wu, Ting-Chun Kuo, Yu-Wen Tien*. Utility of the

2006 Sendai and 2012 Fukuoka guidelines for the Management of Intraductal Papillary Mucinous

Neoplasm of the Pancreas: A Single-Center Experience with 138 Surgically Treated Patients.

Medicine 2016 (in press). (corresponding author).

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Surgical Implications of Neoadjuvant Therapy for Pancreatic Cancer

Yu-Wen Tien, Department of Surgery, National Taiwan University Hospital

田郁文、台大醫院一般外科

In spite of recent advancement in chemotherapy and radiotherapy, operation remains to be

the only potential curative treatment modality for pancreatic ductal cell adenocarcinoma

(PDAC). Most studies reported a margin-negative resection was critical to long-term survival.

Therefore, in clinical practice, pretreatment staging of PDAC, based on the feasibility to

obtain a margin-negative resection, classifies patients into four groups: resectable, borderline

resectable, unresectable (locally advanced), and metastatic ones. But the clinical reality is

only 15% to 20% of PDACs are classified as resectable at time of their diagnosis. Patients

with borderline resectable and unresectable PDAC are fundamentally different from those

with resectable diseases in that they are at higher risk for harboring radiographically occult

distant metastatic disease, at the high possible risk for a positive margin of resection due to

tumor-artery abutment, and in need of a more complex operation usually requiring vascular

resection and reconstruction. Therefore, there is a greater possibility that, despite the best

efforts of the physician team, in individual patients the treatment may be worse than the

disease. The initial enthusiasm for neoadjuvant therapy for patients with borderline resectable

PDAC is patient selection: obviating surgery in those with rapidly progressive disease who

would not benefit from the procedure. But in the era of more effective systemic therapies,

neoadjuvant therapy is being reconsidered that patients with more advanced disease (locally

advanced PC) followed by chemoradiation, were not only still standing after induction

therapy but also appeared to demonstrate tumor response. The objective responses seen

radiographically and biochemically (CA19-9) then prompted reconsideration of surgery and

the tumors were removed in most patients. Most importantly, those patients who completed

all therapy, including surgery, had an improved survival duration even when compared to

patients with earlier stage (resectable) disease treated with surgery first. Therefore the current

enthusiasm for the neoadjuvant therapy for PDAC is the encouraging survival duration of

those who respond.

14

CURRICULUM VITAE

陳世欽醫師, Shih-Chin Chen, MD

學歷：臺北醫學大學醫學系畢 (2000 - 2007)

經歷：台北榮民總醫院 一般外科 主治醫師 Aug.2015 – Currently

台北榮民總醫院桃園分院 一般外科 主治醫師 Dec.2015 – Dec.2016

台北榮民總醫院 一般外科 臨床研究員 Jul.2014 – Jul.2015

台北榮民總醫院 一般外科 住院總醫師 Jul.2013 – Jun.2014

台北榮民總醫院 一般外科 住院醫師 Aug.2009. – Jun.2013

專長：胰臟手術

消化外科

腹腔鏡微創手術

疝氣手術

內分泌外科 (甲狀腺及副甲狀腺手術)

乳房外科

腹部急症手術

電子信箱 scchen19@vghtpe.gov.tw

Cschin0505@gmail.com

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Familial chronic pancreatitis in twin

陳世欽 王心儀 石宜銘 蘇正熙

台北榮民總醫院 及 振興醫院 一般外科

In this presentation, we will present familial chronic pancreatitis in both twin, and

treatment \ dilemma will be discussed.

A 34-year-old male patient presented a picture of malignant jaundice with progressive,

umremittent, afebrile yellowish skin discoloration and clay stool. The CT scan MRCP showed

dilated pancreatic duct with some intraductal filling defect, suspected pancreatic duct stone

disease with chronic pancreatitis and tumor growth could not be ruled out. Unfortunately, it

turned out to be unresectable due to great vessel involvement, and patient died 4 months after

bypass surgery.

Four year later, his twin brother, 38 year old, came to our hospital with the same picture

of chronic pancreatitis in whole pancreas. The tumor markers (CEA and CA 19-9) were

within normal limits.

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張學豪 簡歷

學歷:台北醫學大學醫學系

服務醫院及單位:台北市立聯合醫院仁愛院區

現職: 台北市立聯合醫院仁愛院區消化內科 fellow 1

Email： jackwang@mail2000.com.tw

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張學豪 醫師

台北市立聯合醫院仁愛院區消化內科

病例摘要:

A 79-year-old man presented with poor appetitie for two months. Tea-colored urine with

progressive yellowish skin were noted. There was no fever, abdominal pain, loss of body

weight. T-bil was 2.53mg/dl and D-bil was 1.64mg/dl. Abdominal sonography revealed mild

left IHDs dilatation without dilated CBD. MRCP showed dilatation of bilateral IHDs, with

equivocal focal wall thickening and enhancement of bile duct suspected at hilar area. ERCP

was done, which revealed IHDs dilatation. Blood IgG4 was 780mg/dl. Liver biopsy was done,

which revealed chronic hepatitis with frequent bridging fibrosis and paucity of bile ducts,

associated with marked ductular proliferation and mild inflammatory activity.