Ninomiya Riki, Sakamoto Hirohiko, Suto Yujin, Obuchi Yasuhiro, Yatsuoka Toshimasa, Nishimura Yoji, Kawashima Yoshiyuki, Amikura Katsumi, Tanaka Yoichi, Nishimura Yu, Kurosumi Masafumi
Division of Gastroenterological Surgery, Saitama Cancer Center.
Gan To Kagaku Ryoho. 2011 Nov;38(12):2369-71.
A 61-year-old woman, who had undergone total gastrectomy and distal splenopancreatectomy with Roux-en Y reconstruction for a gastric cancer 16 years earlier, was found primary small intestinal cancer located in intestinal loop of Roux- en Y in gastrointestinal endoscopy for abdominal pain. Computed tomography showed liver metastases which were 8 cm in diameter at lateral segment and 1 cm in diameter at segment 8 of the liver. In the operation, the small intestinal cancer was located in the ρ-anastomosis in the loop of Roux-en Y with the other jejunum fistula. We performed lateral segment hepatectomy, partial hepatectomy of segment 8, partial resection of small intestine including loop of ρ-Roux-en Y, partial resection of transverse colon, and restoration Roux-en Y again. We succeeded in preserving double tract anastomosis at duodenum. Histological examination revealed a moderately differentiated adenocarcinoma of the small intestine and segment 8 of the liver, and angiomyolipoma of lateral segment of the liver. It is extremely rare for small intestinal cancer to arise in a loop of Roux-en Y reconstruction caused by total gastrectomy.
一名61岁女性，16年前因胃癌接受了全胃切除术及远端脾胰切除术并进行了Roux-en Y重建，因腹痛行胃肠内镜检查时发现原发性小肠癌位于Roux-en Y肠袢。计算机断层扫描显示肝脏转移瘤，肝外侧段直径8 cm，肝8段直径1 cm。手术中，小肠癌位于Roux-en Y肠袢的ρ吻合处并伴有另一空肠瘘。我们进行了肝外侧段切除术、肝8段部分切除术、包括ρ-Roux-en Y肠袢在内的小肠部分切除术、横结肠部分切除术，并再次重建Roux-en Y。我们成功保留了十二指肠双道吻合。组织学检查显示为小肠及肝8段中分化腺癌，肝外侧段血管平滑肌脂肪瘤。全胃切除术后Roux-en Y重建肠袢发生小肠癌极为罕见。
