Okoshi Kae, Mizumoto Masaki, Kinoshita Koichi
Department of Surgery, Japan Baptist Hospital, Kyoto, Japan.
Asian J Endosc Surg. 2016 Nov;9(4):303-306. doi: 10.1111/ases.12304. Epub 2016 Jun 22.
A 42-year-old woman presented with abdominal pain. On the basis of CT results, we diagnosed her condition as bowel obstruction caused by advanced transverse colon cancer. Colonoscopy findings showed three lesions: (i) an advanced tumor in the transverse colon; (ii) a laterally spreading descending colon tumor; and (iii) a rectal polyp. The tumors and the polyp were all pathologically diagnosed as adenocarcinoma. After inserting a self-expanding metallic stent into the main tumor of the transverse colon to decompress the bowel, we performed endoscopic submucosal dissection of the laterally spreading descending colon tumor. Pathological examination results showed submucosal invasion and a positive margin. Because we endoscopically identified that the rectal polyp was invading the submucosa, we performed laparoscopic subtotal proctocolectomy and ileorectal anastomosis with lymph node dissection along the surgical trunk; we also performed central vascular ligation of the ileocolic artery, right and left branches of the middle colic artery, and inferior mesenteric artery. The patient's postoperative course was uneventful. We present this case because there have been few reports on laparoscopic subtotal or total proctocolectomy for synchronous multiple colorectal cancers.
一名42岁女性因腹痛就诊。根据CT结果，我们将她的病情诊断为晚期横结肠癌导致的肠梗阻。结肠镜检查发现三个病变：（i）横结肠的晚期肿瘤；（ii）降结肠侧向扩散肿瘤；（iii）直肠息肉。这些肿瘤和息肉均经病理诊断为腺癌。在将自膨式金属支架插入横结肠的主要肿瘤以解除肠道梗阻后，我们对降结肠侧向扩散肿瘤进行了内镜黏膜下剥离术。病理检查结果显示有黏膜下浸润且切缘阳性。由于我们在内镜下发现直肠息肉侵犯黏膜下层，于是进行了腹腔镜低位前切除术和回直肠吻合术，并沿手术主干进行淋巴结清扫；我们还对回结肠动脉、中结肠动脉左右分支以及肠系膜下动脉进行了中央血管结扎。患者术后恢复顺利。我们报告此病例是因为关于腹腔镜低位或全直肠结肠切除术治疗同步性多发结直肠癌的报道较少。
