Nakamoto Hiroki, Nishikawa Makoto, Ishikawa Takahisa, Yokoyama Ryouji, Taketomi Akinobu
Department of Surgery, Abashiri-Kosei General Hospital, Abashiri, Hokkaido, Japan.
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Am J Case Rep. 2019 Jan 1;20:1-4. doi: 10.12659/AJCR.911974.
BACKGROUND One treatment for colon endoluminal tumors is endoscopic resection, i.e., endoscopic mucosal resection (EMR). In this report we describe a case of an endoluminal tumor resected safely and completely by combined endoscopic and laparoscopic surgery (CELS). CASE REPORT A 70-year-old female was admitted to our hospital for cholelithiasis, and we planned a cholecystectomy. She had a surgical history for endometrial cancer, and she was taking amlodipine 2.5 mg/day for hypertension. A preoperative colonoscopy for screening revealed an 18-mm endoluminal tumor in the sigmoid colon. We tried to resect it by EMR, but flexion of the colon, which was considered to be due to adhesion from the former surgical treatment, was severe, so it was difficult to resect the endoluminal tumor by endoscopy. We conducted laparoscopic cholecystectomy and sigmoid colon mobilization. Sigmoid colon flexion was released, enabling us to conduct EMR to the endoluminal tumor. No intraoperative or postoperative complications were observed. CONCLUSIONS CELS can make an endoluminal tumor resectable by EMR without colon resection, and performing simultaneous CELS and laparoscopic cholecystectomy is less invasive.
背景 结肠腔内肿瘤的一种治疗方法是内镜切除术,即内镜黏膜切除术(EMR)。在本报告中,我们描述了一例通过内镜与腹腔镜联合手术(CELS)安全、完整切除腔内肿瘤的病例。病例报告 一名70岁女性因胆结石入院,我们计划为其进行胆囊切除术。她有子宫内膜癌手术史,因高血压正在服用氨氯地平,每日2.5毫克。术前结肠镜筛查发现乙状结肠有一个18毫米的腔内肿瘤。我们试图通过EMR切除该肿瘤,但由于既往手术治疗导致的粘连,结肠弯曲严重,因此难以通过内镜切除腔内肿瘤。我们进行了腹腔镜胆囊切除术和乙状结肠游离术。乙状结肠弯曲得以解除,使我们能够对腔内肿瘤进行EMR。未观察到术中或术后并发症。结论 CELS可使腔内肿瘤通过EMR切除而无需进行结肠切除,同时进行CELS和腹腔镜胆囊切除术的侵入性较小。