Khaled Yazan S, Ammori Mohannad B, Sharif Hassan I, Ammori Basil J
The University of Manchester, The Department of Hepato-Pancreato-Biliary, North Manchester General Hospital, Manchester, UK.
Surg Laparosc Endosc Percutan Tech. 2012 Apr;22(2):e79-82. doi: 10.1097/SLE.0b013e318243a520.
Laparoscopic surgery has extended its applications to resection of malignancies with favorable results. We report the first successful simultaneous laparoscopic subtotal colectomy and pancreaticoduodenectomy (PD) in a patient with familial adenomatous polyposis (FAP).
A 37-year-old man presented with obstructive jaundice. Gastroscopy and biopsies revealed a large ampullary tubulovillous adenoma with mild dysplasia (Spigelman stage III). A colonoscopy for suspicion of FAP revealed numerous right-sided polyps with left-sided sparing. Computed tomography showed a double duct sign. A simultaneous laparoscopic subtotal colectomy and PD was performed successfully. The operative time was 225 minutes for the colectomy and 390 minutes for the PD. Histology showed an R0 resection of ampullary adenocarcinoma (20 negative nodes) and colonic polyps with low-grade dysplasia. Genetic screening confirmed a diagnosis of FAP.
A simultaneous laparoscopic subtotal colectomy and PD in patients with FAP and ampullary neoplasia seems safe with favorable clinical and oncologic outcomes.
腹腔镜手术已将其应用扩展至恶性肿瘤切除术，并取得了良好效果。我们报告了首例成功的腹腔镜下同时行次全结肠切除术和胰十二指肠切除术（PD）治疗家族性腺瘤性息肉病（FAP）患者的病例。
一名37岁男性因梗阻性黄疸就诊。胃镜检查及活检发现一个巨大的壶腹管绒毛状腺瘤伴轻度发育异常（斯皮格尔曼Ⅲ期）。因怀疑FAP而行结肠镜检查，发现右侧有大量息肉，左侧未见。计算机断层扫描显示双管征。成功实施了腹腔镜下同时次全结肠切除术和PD。结肠切除术的手术时间为225分钟，PD的手术时间为390分钟。组织学检查显示壶腹腺癌切缘阴性（20个淋巴结阴性），结肠息肉为低级别发育异常。基因筛查确诊为FAP。
对于FAP合并壶腹肿瘤患者，腹腔镜下同时行次全结肠切除术和PD似乎是安全的，具有良好的临床和肿瘤学结局。
