Takemoto Yoshihiro, Harada Eijiro, Takeuchi Yuriko, Kawamura Daichi, Suehiro Yuuki, Kugimiya Naruji, Hamano Kimikazu
Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
Asian J Endosc Surg. 2018 Feb;11(1):60-63. doi: 10.1111/ases.12409. Epub 2017 Jul 6.
A 65-year-old man presented with bloody stool. Colonoscopy revealed a raised tumor in the rectum, above the peritoneal reflection. He underwent endoscopic mucosal resection, but the pathological findings suggested the possibility of residual cancer. We performed laparoscopic low anterior resection using a circular stapling instrument for additional curative surgery. However, we could not insert the shaft of the endoscopic circular stapler from the anus because of anal stenosis due to Whitehead's hemorrhoidectomy the patient had undergone 20 years earlier. Therefore, we planned to use a linear stapler to insert an anvil into the rectum. The cartridge-carrying instrument was inserted from the sigmoidal side, and we performed a side-to-end anastomosis. The patient was discharged without anastomotic leakage or defecation disorder. We present this case because laparoscopic low anterior resection for rectal cancer with anal stenosis has not been previously reported.
一名65岁男性因便血就诊。结肠镜检查发现直肠腹膜反折上方有一隆起性肿瘤。他接受了内镜黏膜切除术，但病理结果提示可能存在残留癌。我们使用圆形吻合器进行腹腔镜低位前切除术以进行进一步的根治性手术。然而，由于患者20年前接受过怀特海德痔切除术导致肛门狭窄，我们无法从肛门插入内镜圆形吻合器的杆身。因此，我们计划使用线性吻合器将砧座插入直肠。从乙状结肠侧插入带钉仓器械，进行端侧吻合。患者出院时无吻合口漏或排便障碍。我们报告此病例是因为此前尚未有关于肛门狭窄的直肠癌患者行腹腔镜低位前切除术的报道。
