Saito Naoto, Ohata Masahiko, Ishii Hiroshi, Ohori Masaki, Tokura Yasuyuki, Maruyama Masanobu, Furukawa Toshitaka, Sato Hideaki
Dept. of Surgery, Maruyama Memorial General Hospital.
Gan To Kagaku Ryoho. 2007 Aug;34(8):1287-90.
The patient was a 63-year-old man,who first visited our hospital with the chief complaints of left lower quadrant pain and abdominal distension that had developed around November 13, 2004. On close examination, he was diagnosed with sigmoid colon cancer, multiple liver metastasis, and subileus due to a lung metastasis. His operation took place on December 12 of the same year. Intraoperatively, the sigmoid colon was firmly fixed to the retroperitonium, there was a hard node in the pouch of Douglas, and that part of the jejunum was involved. The lesion was judged to be unresectable,and thus loop colostomy, partial jejunectomy and gastrojejunostomy were performed. After the surgery,the patient was treated with 4 courses of therapy with oral Leucovorin (LV, 75 mg) +oral tegafur/uracil (UFT, 400 mg). As a result, the tumor marker levels decreased markedly, the lung metastasis was no longer observed and the liver metastases became smaller. Therefore, a second-look operation was performed on May 30, 2005. This time it was relatively easy to free the sigmoid colon. The node in the pouch of Douglas was no longer observed, and there were only 2 metastatic lesions in the liver (1 each in S 2 and S 6). Sigmoidectomy and partial hepatectomy were performed, and the stoma was closed. The patient made good progress after the operation and was discharged on the 11 th POD. At present he is receiving chemotherapy with UFT+oral LV as an outpatient. As this therapy is relatively easy to perform and imposes only a small burden on patients,we think that it may be effective not only as adjuvant chemotherapy but also as neoadjuvant chemotherapy in some patients.
患者为一名63岁男性,于2004年11月13日左右首次因左下腹疼痛和腹胀为主诉前来我院就诊。经详细检查,他被诊断为乙状结肠癌、多发肝转移以及因肺转移导致的不全肠梗阻。同年12月12日进行了手术。术中发现乙状结肠与后腹膜紧密粘连,Douglas窝有硬结节,空肠部分受累。病变被判定为无法切除,因此进行了袢式结肠造口术、部分空肠切除术和胃空肠吻合术。术后,患者接受了4个疗程的口服亚叶酸钙(LV,75mg)+口服替加氟/尿嘧啶(UFT,400mg)治疗。结果,肿瘤标志物水平显著下降,肺转移未再观察到,肝转移灶变小。因此,于2005年5月30日进行了二次探查手术。这次游离乙状结肠相对容易。Douglas窝的结节未再发现,肝脏仅有2个转移病灶(S2和S6各1个)。进行了乙状结肠切除术和部分肝切除术,并关闭了造口。患者术后恢复良好,术后第11天出院。目前他作为门诊患者正在接受UFT+口服LV化疗。由于这种治疗相对容易实施,对患者负担较小,我们认为它不仅作为辅助化疗可能有效,而且在某些患者中作为新辅助化疗也可能有效。