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[一例老年患者小肠癌单切口腹腔镜手术病例]

[A case of an elderly patient who underwent single-incision laparoscopic surgery for small intestine cancer].

作者信息

Hashimoto Yoshifumi, Kameyama Hitoshi, Hirose Yuki, Yagi Ryoma, Nakano Mae, Sato You, Kido Tomoki, Ichikawa Hiroshi, Hanyu Takaaki, Nakano Masato, Ishikawa Takashi, Shimada Yoshifumi, Kobayashi Takashi, Sakata Jun, Minagawa Masahiro, Kosugi Shinichi, Koyama Yu, Wakai Toshifumi

机构信息

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences.

出版信息

Gan To Kagaku Ryoho. 2014 Nov;41(12):2442-3.

Abstract

An 81-year-old man presented with chief complaints of abdominal pain and vomiting. Intestinal obstruction was found at the time of admission to a local hospital in October 2011. Conservative treatment provided symptomatic relief; however, he was readmitted with similar symptoms in December 2011. Small-intestinal wall thickening was detected by abdominal and pelvic computed tomography, and he was referred to our hospital. Small-bowel endoscopy revealed an elevated subcircumferential tumor in the jejunum. Biopsy revealed well to moderately differentiated adenocarcinoma diagnosed as jejunal cancer, which caused narrowing of the jejunum. Single-incision laparoscopy-assisted small-bowel resection was performed. The intraoperative findings were a tumor with inflammatory changes in the jejunum and enlarged surrounding lymph nodes. We performed regional lymph node dissection. Histopathological analysis showed moderately differentiated small-intestinal tubular adenocarcinoma and 2 of 5 lymph nodes positive for metastatic cancer cells. After an uneventful postoperative course, he was discharged on day 7. He preferred not to undergo postoperative adjuvant chemotherapy and quickly recovered his activities of daily living postoperatively. He stayed home until he developed abdominal distention resulting from peritoneal recurrence 1 year and 6 months postoperatively and died 1 month later.

摘要

一名81岁男性因腹痛和呕吐为主诉就诊。2011年10月入住当地医院时发现肠梗阻。保守治疗缓解了症状;然而,他在2011年12月因类似症状再次入院。腹部和盆腔计算机断层扫描检测到小肠壁增厚,随后他被转诊至我院。小肠内镜检查发现空肠有一个环形隆起的肿瘤。活检显示为中分化腺癌,诊断为空肠癌,导致空肠狭窄。实施了单切口腹腔镜辅助小肠切除术。术中发现空肠有一个伴有炎症改变的肿瘤,周围淋巴结肿大。我们进行了区域淋巴结清扫。组织病理学分析显示为中分化小肠管状腺癌,5个淋巴结中有2个有癌细胞转移阳性。术后过程顺利,他于术后第7天出院。他不愿接受术后辅助化疗,术后很快恢复了日常生活活动。他一直居家,直到术后1年6个月因腹膜复发出现腹胀,1个月后死亡。

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