Nakata Y, Kimura K, Tomioka N, Kawasaki S, Takagaki Y
Department of Surgery, Kita Ishikai Hospital, Tokunomori, Oozu, Ehime, Japan.
Surg Today. 1999;29(8):782-4. doi: 10.1007/BF02482327.
In an 83-year-old Japanese man, concomitant bleeding colon cancer, early gastric cancer, and an expanding right common iliac artery aneurysm were evident. The patient underwent an artificial graft implantation, partial gastrectomy, and transverse colectomy, simultaneously. To protect against graft infection, the aneurysm was resected first, and then the retroperitoneum was tightly closed to isolate the graft from the peritoneal cavity. The postoperative course was uneventful, except for symptoms of temporary delirium. Recently, simultaneous surgery for concomitant abdominal aortic aneurysms and early gastric cancer has been commonly performed in Japan because the contamination of the peritoneal cavity during a gastrectomy is thought to be less severe than that during lower abdominal surgery. However, the positive rate for bacterial culture in colorectal resections is virtually the same as that in gastrectomies. Moreover, the incidence of graft infection is substantially lower than the positive rate for bacterial culture in surgery for aneurysms. Some surgeons object to a simultaneous resection due to fear of graft infection, but even the presence of infectious organisms does not always result in graft infection. The present case illustrates the benefits of a simultaneous operation for both an aneurysm and gastrointestinal malignancy.
在一名83岁的日本男性患者中，同时发现了结肠出血性癌、早期胃癌以及不断增大的右侧髂总动脉瘤。该患者同时接受了人工血管植入术、部分胃切除术和横结肠切除术。为防止移植物感染，首先切除动脉瘤，然后紧密缝合后腹膜，以将移植物与腹腔隔离。术后过程顺利，仅出现了短暂谵妄症状。最近，在日本，同时进行腹主动脉瘤和早期胃癌手术已较为常见，因为人们认为胃切除术中腹腔的污染程度低于下腹部手术。然而，结直肠切除术的细菌培养阳性率与胃切除术几乎相同。此外，移植物感染的发生率远低于动脉瘤手术的细菌培养阳性率。一些外科医生因担心移植物感染而反对同时进行切除手术，但即使存在感染性生物体也并不一定会导致移植物感染。本病例说明了同时进行动脉瘤和胃肠道恶性肿瘤手术的益处。
