Kawakita Hideaki, Aota Yasuo, Osaka Yoshiaki, Kato Fumiaki, Sugiyama Yuji, Kuboyama Yu, Enomoto Masanobu, Ishizaki Tetsuo, Nagakawa Yuichi, Katsumata Kenji, Tsuchida Akihiko
Dept. of Gastrointestinal and General Surgery, Kohsei Chuo General Hospital.
Gan To Kagaku Ryoho. 2020 Dec;47(13):2117-2119.
The aplastic anemia(AA)syndrome is characterized by pancytopenia and bone marrow hypoplasia. Although anemia, bleeding tendency, and susceptibility to infection are issues of concern during surgery, few reports have been published on the perioperative management, and management methods have not been established. A 77-year-old woman visited our hospital with chief complaints of melena and fatigability. Marked pancytopenia was observed at the first visit. After a detailed examination, she was diagnosed with ascending colon cancer accompanied by AA and solitary liver metastasis. As AA responded poorly to treatment, without improvement in pancytopenia, we decided to perform colectomy. The perioperative management, including blood transfusion and administration of a G-CSF preparation, was performed in collaboration with a hematologist, followed by right hemicolectomy and hepatic lateral segmentectomy. She was transferred to the department of hematology on hospital day 8 without complications. In conclusion, a highly invasive surgery, as in the present case, can be performed safely with an appropriate perioperative management even in cases complicated by AA.
再生障碍性贫血（AA）综合征的特征是全血细胞减少和骨髓发育不全。虽然贫血、出血倾向和对感染的易感性是手术期间令人关注的问题，但关于围手术期管理的报道很少，且管理方法尚未确立。一名77岁女性因黑便和疲劳为主诉前来我院就诊。初诊时发现明显的全血细胞减少。经过详细检查，她被诊断为升结肠癌伴AA和孤立性肝转移。由于AA对治疗反应不佳，全血细胞减少没有改善，我们决定进行结肠切除术。与血液科医生合作进行了包括输血和给予粒细胞集落刺激因子制剂在内的围手术期管理，随后进行了右半结肠切除术和肝外侧段切除术。她在术后第8天无并发症地转入血液科。总之，即使在合并AA的病例中，通过适当的围手术期管理，如本病例中的高侵袭性手术也可以安全进行。
