Negoi Ionuţ, Runcanu Alexandru, Paun Sorin, Beuran Mircea
Chirurgia (Bucur). 2016 Nov-Dec;111(6):522-526. doi: 10.21614/chirurgia.111.6.522.
Twenty percent of patients with colorectal cancer present stage IV disease at the time of diagnosis. The Crohn's disease increases 20 times the risk of colorectal cancer and worsens the patients' prognosis. The objective of this case report is to illustrate the surgical resection of a liver metachronous metastasis of colon cancer origin in a patient with Crohn's disease.
A 53-year old female patient was admitted to our hospital for a colon cancer metachronous liver metastasis. The patient was diagnosed for more than ten years with colonic Crohn's disease and ankylosing spondylitis. She had a Hartmann's type resection for sigmoid colon adenocarcinoma four years ago, and a secondary resection of the transverse colon with a right transverse colostomy for colonic stenosis one month before current admission. Abdominal Computed Tomography revealed a liver metastasis of 10/11 cm located in segments 6, 7, 8, in close contact with the right and middle hepatic veins and right Glissonian pedicle. A right hemihepatectomy was performed, using Pringle maneuver for 30 minutes. The patient was discharged after 12 days, without additional morbidities. Patients with liver metastases of colorectal origin in the presence of Crohn's disease come with significant clinical challenges. Inside the multimodality approach, liver resection represents the therapeutic approach associated with the best long-term oncological results.
20%的结直肠癌患者在确诊时已处于IV期疾病。克罗恩病使患结直肠癌的风险增加20倍，并使患者预后恶化。本病例报告的目的是说明对一名患有克罗恩病的结肠癌肝异时转移患者进行手术切除的情况。
一名53岁女性患者因结肠癌肝异时转移入住我院。该患者被诊断为结肠克罗恩病和强直性脊柱炎超过十年。四年前她因乙状结肠腺癌接受了哈特曼氏型切除术，入院前一个月因结肠狭窄接受了横结肠二次切除术及右横结肠造口术。腹部计算机断层扫描显示肝脏有一个10/11厘米的转移灶，位于6、7、8段，与右肝中静脉和右肝蒂紧密相连。采用普林格尔手法30分钟后进行了右半肝切除术。患者术后12天出院，无其他并发症。患有克罗恩病的结直肠癌肝转移患者面临重大临床挑战。在多模式治疗方法中，肝切除术是与最佳长期肿瘤学结果相关的治疗方法。
