Yamamoto Ryusei, Mokuno Yasuji, Matsubara Hideo, Kaneko Hirokazu, Iyomasa Shinsuke
Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan.
J Med Case Rep. 2018 Feb 6;12(1):28. doi: 10.1186/s13256-017-1555-1.
Rectal cancer with rectal prolapse is rare, described by only a few case reports. Recently, laparoscopic surgery has become standard procedure for either rectal cancer or rectal prolapse. However, the use of laparoscopic low anterior resection for rectal cancer with rectal prolapse has not been reported.
A 63-year-old Japanese woman suffered from rectal prolapse, with a mass and rectal bleeding for 2 years. An examination revealed complete rectal prolapse and the presence of a soft tumor, 7 cm in diameter; the distance from the anal verge to the tumor was 5 cm. Colonoscopy demonstrated a large villous tumor in the lower rectum, which was diagnosed as adenocarcinoma on biopsy. We performed laparoscopic low anterior resection using the prolapsing technique without rectopexy. The distal surgical margin was more than 1.5 cm from the tumor. There were no major perioperative complications. Twelve months after surgery, our patient is doing well with no evidence of recurrence of either the rectal prolapse or the cancer, and she has not suffered from either fecal incontinence or constipation.
Laparoscopic low anterior resection without rectopexy can be an appropriate surgical procedure for rectal cancer with rectal prolapse. The prolapsing technique is useful in selected patients.
伴有直肠脱垂的直肠癌较为罕见，仅有少数病例报告。近年来，腹腔镜手术已成为直肠癌或直肠脱垂的标准术式。然而，腹腔镜低位前切除术用于伴有直肠脱垂的直肠癌尚未见报道。
一名63岁日本女性患有直肠脱垂，伴有肿物及直肠出血2年。检查发现完全性直肠脱垂及一个直径7 cm的软质肿瘤；肿瘤距肛缘5 cm。结肠镜检查显示直肠下段有一个大的绒毛状肿瘤，活检诊断为腺癌。我们采用脱垂技术行腹腔镜低位前切除术，未行直肠固定术。手术切缘距肿瘤超过1.5 cm。围手术期无严重并发症。术后12个月，患者恢复良好，无直肠脱垂或癌症复发迹象，也未出现大便失禁或便秘。
不行直肠固定术的腹腔镜低位前切除术可作为伴有直肠脱垂的直肠癌的一种合适手术方式。脱垂技术对特定患者有用。
