Hyakutake Yoshiaki, Kawamoto Jun, Uchi Reona, Yamada Hideyuki, Matsuyama Naoki, Shu Tatsuhito, Fujii Kouya, Funatsu Yuya, Yamamoto Yuya, Otsuka Masayuki
Dept. of General Surgery, Kyoundo Hospital.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1937-1939.
The patient was an 85-year-old man who received chemotherapy with gemcitabine for 2 years 9 months under the diagnosis of unresectable locally advanced pancreatic body and tail cancer. He visited our hospital because of anorexia, upper abdominal fullness, and vomiting. A CT scan showed severe stenosis in the third portion of the duodenum, which was associated with the direct invasion of the advanced pancreatic cancer. Upper gastrointestinal fiberscopy revealed a severe duodenal obstruction; however, pancreatic cancer exposure within the duodenal mucosa was not observed. As the stenosis of the duodenum was relatively smooth because of the cancer invasion into only the submucosa, deviation of the metallic stent was possible, so we performed laparoscopic gastrojejunostomy. We started the surgery with 5-port settings. A slit was made in the gastric body by using ENDO-GIA®, and bypass surgery with a Roux-en-Y anastomosis was performed. The postoperative course was good, and oral intake resumed on the third postoperative day. Thereafter, he could leave the hospital with good progress and received systemic chemotherapy using gemcitabine. In the present case, an extramural gastrointestinal stenosis without cancer that was not exposed in the gastrointestinal mucosa was poorly fixed with gastrointestinal metallic stents and use of a deviating metallic stent was reported, so we chose laparoscopic gastrojejunostomy. In addition, after undergoing laparoscopic surgery, which is a minimally invasive treatment, he recovered quickly and shifted early to systemic chemotherapy. Herein, the usefulness of laparoscopic gastrojejunostomy for extramural stenosis is reported with a review of related literature.
该患者为一名85岁男性，因诊断为无法切除的局部晚期胰体尾癌接受吉西他滨化疗2年9个月。他因食欲不振、上腹部饱胀和呕吐前来我院就诊。CT扫描显示十二指肠第三段严重狭窄，这与晚期胰腺癌的直接侵犯有关。上消化道纤维内镜检查显示十二指肠严重梗阻；然而，未观察到十二指肠黏膜内有胰腺癌浸润。由于癌症仅侵犯黏膜下层，十二指肠狭窄相对平滑，金属支架可能会移位，因此我们进行了腹腔镜胃空肠吻合术。我们以五孔法开始手术。使用内镜切割吻合器（ENDO - GIA®）在胃体部做一切口，并进行了Roux - en - Y吻合的旁路手术。术后过程顺利，术后第三天恢复经口进食。此后，他恢复良好并出院，继续接受吉西他滨全身化疗。在本病例中，报道了一种未暴露于胃肠道黏膜的无癌性壁外胃肠道狭窄，使用胃肠道金属支架固定不佳且金属支架会移位，因此我们选择了腹腔镜胃空肠吻合术。此外，在接受作为微创治疗的腹腔镜手术后，他恢复迅速并尽早转向全身化疗。在此，通过回顾相关文献报道了腹腔镜胃空肠吻合术治疗壁外狭窄的有效性。
