Mukai Masaya, Tanaka Akira, Tajima Takayuki, Fukasawa Maki, Yamagiwa Takeshi, Okada Ken-Ichi, Sato Kazuhiko, Tobita Kousuke, Oida Yasuhisa, Makuuchi Hiroyasu
Tokai University Hachioji Hospital, Department of Surgery, Tokyo 192-0032, Japan.
Oncol Rep. 2008 Apr;19(4):875-9.
A 69-year-old woman presented to her local clinic with vomiting and abdominal distension. Since a bowel obstruction by left colon cancer was suspected due to a marked dilation of the transverse colon, she was referred to our hospital. On admission, an enema disclosed a complete obstruction at the splenic flexure of the colon. An emergency operation was performed, and a temporary loop colostomy was fashioned on the left side of the transverse colon within the range of resection for 2-stage radical surgery. On hospital day 16, a left hemicolectomy D2 was performed by 2-port hand-assisted laparoscopic surgery (2P-HALS) using the stoma as the hand access site, and the tumor was resected along with the removal of the stoma. After surgery, a slight wound infection occurred at the hand access site, but this healed with conservative management. On day 36, she was discharged from hospital. The histological diagnosis was Type 2 circumferential well-differentiated adenocarcinoma with local peritoneal dissemination. Our experience suggests that 2-stage surgery combined with 2P-HALS is applicable even to a large obstructing left colon cancer. This method is less invasive, safe and achieves excellent results, including a good cosmetic outcome.
一名69岁女性因呕吐和腹胀前往当地诊所就诊。由于横结肠明显扩张，怀疑是左结肠癌导致肠梗阻，遂转诊至我院。入院时，灌肠检查发现结肠脾曲完全梗阻。进行了急诊手术，在横结肠左侧做了一个临时袢式结肠造口术，范围在二期根治性手术的切除范围内。术后第16天，采用双孔手辅助腹腔镜手术（2P-HALS），以造口作为手辅助入路部位，进行了左半结肠D2切除术，切除肿瘤的同时移除了造口。术后，手辅助入路部位出现轻度伤口感染，但经保守治疗后愈合。术后第36天，患者出院。组织学诊断为2型环状高分化腺癌伴局部腹膜播散。我们的经验表明，二期手术联合2P-HALS即使对于大型梗阻性左结肠癌也适用。该方法创伤小、安全，效果良好，包括美容效果也佳。
