Noda Hiroshi, Kato Takaharu, Kamiyama Hidenori, Toyama Nobuyuki, Konishi Fumio
Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
Clin J Gastroenterol. 2010 Oct;3(5):259-61. doi: 10.1007/s12328-010-0175-8. Epub 2010 Sep 16.
A 58-year-old female was referred to our hospital with a diagnosis of bowel obstruction due to advanced transverse colon cancer invading the duodenum. Two months after the emergency bypass operation for the bowel obstruction, we performed an en bloc right hemicolectomy with pancreaticoduodenectomy (RHCPD) with a curative intent. During the operation, we could not dissect the tumor from the superior mesenteric vein, so we performed a segmental cylindrical resection of the superior mesenteric vein and its reconstruction. The post-operative course was uneventful, and after a 34-day hospital stay the patient returned to daily life. A histologic examination also revealed a well-differentiated tubular adenocarcinoma invading the duodenum. All the surgical margins were negative and lymph node metastasis was not found. There were no signs of recurrence for 8 months after the operation. Complete resection clearly influences survival time of patients, and surgeons should not hesitate to perform RHCPD.
一名58岁女性因晚期横结肠癌侵犯十二指肠导致肠梗阻被转诊至我院。在因肠梗阻进行急诊旁路手术后两个月，我们进行了旨在根治的整块右半结肠切除术联合胰十二指肠切除术（RHCPD）。手术过程中，我们无法将肿瘤从肠系膜上静脉分离，因此对肠系膜上静脉进行了节段性柱状切除并重建。术后病程平稳，患者住院34天后恢复日常生活。组织学检查显示为侵犯十二指肠的高分化管状腺癌。所有手术切缘均为阴性，未发现淋巴结转移。术后8个月无复发迹象。完整切除显然会影响患者的生存时间，外科医生应毫不犹豫地进行RHCPD。
