Okabe Yasuyuki, Yajima Kazuhito, Ishikawa Takashi, Kosugi Shin-ichi, Sakamoto Kaoru, Sato Yu, Kanda Tatsuo, Wakai Toshifumi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences.
Gan To Kagaku Ryoho. 2014 Jan;41(1):95-8.
A 66 -year-old man presenting with a chief complaint of upper abdominal pain was diagnosed as having an advanced adenocarcinoma, type 2, of the lower third of the stomach after endoscopy was performed. An abdominal computed tomography( CT)scan revealed 4 lymph node metastases at the infrapyloric nodes(station No. 6)and the nodes around the proximal splenic artery(station No. 11p)and the abdominal aorta(station No. 16a2). The clinical stage was determined to be T3(SS)N2M1(LYM), Stage IV. Gastrectomy with D2 plus para-aortic node dissection was scheduled after 2 courses of S-1 plus cisplatin(CDDP)with curative intent. On day 14 after starting S-1 therapy, the patient complained of severe abdominal pain and peritoneal irritation of acute onset. Because the abdominal CT scan showed a large amount of intra-abdominal free air, we performed an urgent laparotomy with a tentative diagnosis of perforation of the gastric cancer. On laparotomy, we found a perforated malignant ulcer, 5 cm in maximum diameter, in the lesser curvature of the stomach; therefore, distal gastrectomy with D1 plus lymphadenectomy and reconstruction using the Roux-en-Y method were performed. At the end of the surgery, a macroscopic residual tumor remained in the para-aortic lymph node. The postoperative course was uneventful, and the patient was discharged on day 23 after surgery. In the present case, despite the performance of urgent gastrectomy while the patient was receiving strong chemotherapy, perioperative management was successful, with no serious postoperative complication or adverse events as a result of the chemotherapy.
一名66岁男性因上腹部疼痛为主诉就诊，在内镜检查后被诊断为胃下三分之一的进展期2型腺癌。腹部计算机断层扫描（CT）显示幽门下淋巴结（第6组）、脾动脉近端周围淋巴结（第11p组）和腹主动脉旁淋巴结（第16a2组）有4处淋巴结转移。临床分期确定为T3（SS）N2M1（LYM），IV期。计划在进行2个疗程的S-1加顺铂（CDDP）化疗后进行D2根治性胃切除术加主动脉旁淋巴结清扫术。在开始S-1治疗后的第14天，患者主诉突发严重腹痛和腹膜刺激征。由于腹部CT扫描显示腹腔内有大量游离气体，我们进行了急诊剖腹手术，初步诊断为胃癌穿孔。剖腹手术时，我们在胃小弯处发现一个直径最大为5 cm的穿孔性恶性溃疡；因此，进行了D1根治性远端胃切除术加淋巴结清扫术，并采用Roux-en-Y法进行重建。手术结束时，主动脉旁淋巴结仍有肉眼可见的残留肿瘤。术后过程顺利，患者在术后第23天出院。在本病例中，尽管患者在接受强烈化疗时进行了急诊胃切除术，但围手术期管理成功，没有因化疗导致严重的术后并发症或不良事件。
