Iwamoto Kazuya, Takahashi Hidekazu, Haraguchi Naotsugu, Nishimura Junichi, Hata Taishi, Matsuda Chu, Yamamoto Hirofumi, Mizushima Tsunekazu, Doki Yuichiro, Mori Masaki
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Asian J Endosc Surg. 2017 Nov;10(4):420-423. doi: 10.1111/ases.12383. Epub 2017 Jun 21.
A 73-year-old man with lower abdominal pain was diagnosed at our hospital with sigmoid colon cancer. He had previously undergone radical cystectomy with Indiana pouch construction and gastrectomy to treat bladder cancer and gastric cancer, respectively. We performed a laparoscopic Hartmann's operation with Japanese D3 lymph node dissection. We observed severe adhesion in the abdominal cavity; adhesions between the urostomy and sigmoid colon were particularly severe. The tumor had invaded to the distal rectum, which had adhered to the pubic bone and the previously reconstructed urinary pouch. By performing careful and persistent laparoscopic dissection, we completed the operation without damaging the urostomy and with no remnant tumor tissue (R0). The postoperative course was uneventful, and the patient was doing well with no evidence of cancer recurrence 1 year after surgery.
一名73岁男性因下腹部疼痛在我院被诊断为乙状结肠癌。他此前分别接受了根治性膀胱切除术并构建回肠膀胱术以及胃切除术，以治疗膀胱癌和胃癌。我们实施了腹腔镜Hartmann手术并进行了日本D3淋巴结清扫。我们观察到腹腔内存在严重粘连；造口与乙状结肠之间的粘连尤为严重。肿瘤已侵犯至直肠远端，直肠与耻骨及先前重建的尿袋粘连。通过仔细且持续的腹腔镜解剖，我们完成了手术，未损伤造口且无残留肿瘤组织（R0）。术后过程顺利，患者术后1年情况良好，无癌症复发迹象。
