Hagihara Kiyotaka, Takahashi Hidekazu, Miyoshi Norikatsu, Haraguchi Naotsugu, Hata Taishi, Matsuda Chu, Mizushima Tsunekazu, Yamamoto Hirofumi, Doki Yuichiro, Mori Masaki
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Asian J Endosc Surg. 2018 Aug;11(3):266-269. doi: 10.1111/ases.12461. Epub 2018 Jan 11.
A 67-year-old man who presented with a bloody stool was diagnosed with ascending colon cancer. He had previously experienced thoracic and abdominal aortic dissections, which were treated with thoracic and abdominal aortic grafts and superior mesenteric artery revascularization. We performed a laparoscopic right hemicolectomy with a D3 lymph node dissection. During the laparotomy, we identified the superior mesenteric artery and an enlarged anterior superior pancreaticoduodenal artery. Injury to the latter artery could lead to severe ischemia in multiple organs; therefore, it was crucial to identify the primary feeding artery and vascular anatomy before and during surgery. We chose the laparoscopic right hemicolectomy to avoid injuring the anterior superior pancreaticoduodenal artery and the intra-abdominal abscess. This case study was the first to describe a laparoscopic hemicolectomy after thoracic and abdominal aortic grafts and superior mesenteric artery revascularization.
一名67岁出现便血的男性被诊断为升结肠癌。他曾经历过胸主动脉和腹主动脉夹层，接受过胸主动脉和腹主动脉移植以及肠系膜上动脉血运重建术。我们进行了腹腔镜右半结肠切除术并清扫D3淋巴结。在剖腹手术过程中，我们识别出了肠系膜上动脉以及增粗的胰十二指肠上前动脉。损伤后一条动脉可能导致多个器官严重缺血；因此，在手术前和手术过程中识别主要供血动脉和血管解剖结构至关重要。我们选择腹腔镜右半结肠切除术以避免损伤胰十二指肠上前动脉和腹腔内脓肿。本病例研究首次描述了在胸主动脉和腹主动脉移植以及肠系膜上动脉血运重建术后进行的腹腔镜半结肠切除术。
