Hamano Genya, Ikebe Takashi, Mayumi Katsuyuki, Takemura Masashi, Hori Takaaki, Nishioka Takayoshi
Dept. of Surgery, Goshi Hospital.
Gan To Kagaku Ryoho. 2013 Jul;40(7):951-4.
A 58-year-old man underwent laparoscopic surgery for rectal cancer(rectal sigmoid)complicated by intestinal obstruction. He had no liver metastasis. Although many nodules suspected to have arisen from peritoneal dissemination were observed in the pelvic cavity, we performed anterior resection assuming that the primary lesion was resectable. The surgical findings were sSE, sN2, sP3, sStage IV, and histopathological findings were signet-ring cell carcinoma, pSE, pN2, pP+, pStage IV. After 8 courses of adjuvant chemotherapy with modified 5-fluorouracil/Leucovorin/oxaliplatin(mFOLFOX6), carcinoembryonic antigen( CEA)decreased to a normal level, and positron emission tomography-computed tomography(PET-CT)showed no abnormal accumulation that suggested metastasis. To evaluate the effectiveness of this procedure, laparoscopic peritoneal biopsy was performed 5 months after surgery, revealing histopathological disappearance of the peritoneal dissemination lesion. The patient has been followed up and has been receiving S-1 for 1 year after the first surgery. No evidence of recurrence has been observed.
一名58岁男性因直肠癌（直肠乙状结肠交界处）合并肠梗阻接受了腹腔镜手术。他没有肝转移。尽管在盆腔中观察到许多疑似由腹膜播散引起的结节，但由于假定原发灶可切除，我们进行了前切除术。手术所见为sSE、sN2、sP3、s分期IV期，组织病理学所见为印戒细胞癌、pSE、pN2、pP+、p分期IV期。在接受8个疗程的改良5-氟尿嘧啶/亚叶酸钙/奥沙利铂（mFOLFOX6）辅助化疗后，癌胚抗原（CEA）降至正常水平，正电子发射断层扫描-计算机断层扫描（PET-CT）显示没有提示转移的异常聚集。为评估该手术的效果，术后5个月进行了腹腔镜腹膜活检，结果显示腹膜播散病灶的组织病理学消失。该患者一直在接受随访，首次手术后已接受S-1治疗1年。未观察到复发迹象。
