Ohta Ryo, Inoue Takahiro, Goto Manabu, Tachimori Yuji, Sekikawa Koji
Department of Surgery, Institute of Gastroenterology, Kawasaki Saiwai Hospital, Kawasaki, Japan.
Department of Surgery, Institute of Gastroenterology, Kawasaki Saiwai Hospital, Kawasaki, Japan.
Int J Surg Case Rep. 2018;44:135-138. doi: 10.1016/j.ijscr.2018.02.027. Epub 2018 Feb 22.
This report presents a case of anorectal malignant melanoma treated with combined laparoscopic abdomino-endoscopic perineal total mesorectal excision.
An 82-year-old female presented with hematochezia. Colonoscopy revealed a 5-cm tumor in the anorectal junction, and biopsy specimen showed malignant melanoma. Modified ransanal total mesorectal excision was performed to get the sufficient surgical resection margins. After lymph node dissection in usual manner, mobilizing the rectum to the level of levator ani muscle. Then a skin incision was made around the anus and the transperineal access platform was placed. The fat tissue of the ischioanal fossa was divided until the levator ani muscle was exposed. The oral side of the colon was transected and specimen was extracted through the perineal incision site. Then stoma was placed laparoscopically.
This procedure provides not only better exposure of the extralevator surgical field, but also efficient resection margins compared with the conventional andominoperineal resection.
To the best of our knowledge, this is the first report of combined laparoscopic abdomino-endoscopic perineal total mesorectal excision for anorectal malignant melanoma. Our experience showed safety and feasible option for anorectal malignant diseases.
本报告介绍了一例采用腹腔镜辅助经腹内镜会阴联合全直肠系膜切除术治疗的肛管直肠恶性黑色素瘤病例。
一名82岁女性因便血就诊。结肠镜检查发现肛管直肠交界处有一个5厘米的肿瘤，活检标本显示为恶性黑色素瘤。采用改良经肛门全直肠系膜切除术以获得足够的手术切缘。按常规方式进行淋巴结清扫，将直肠游离至肛提肌水平。然后在肛门周围做皮肤切口并放置经会阴入路平台。切开坐骨直肠窝的脂肪组织直至暴露肛提肌。横断结肠近端，经会阴切口取出标本。然后通过腹腔镜造口。
与传统的经腹会阴切除术相比，该手术不仅能更好地暴露肛提肌外手术视野，还能获得有效的手术切缘。
据我们所知，这是首例关于腹腔镜辅助经腹内镜会阴联合全直肠系膜切除术治疗肛管直肠恶性黑色素瘤的报告。我们的经验表明，该手术对于肛管直肠恶性疾病是一种安全可行的选择。
