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成功施行腹腔镜辅助整块切除术治疗累及升结肠和多发淋巴结转移的巨大肠系膜恶性淋巴瘤:一例儿科高难度病例报告。

Successful laparoscopy-assisted en bloc resection of bulky omental malignant lymphoma involving the ascending colon and multiple lymph node metastases: Report of a technically demanding case in a pediatric patient.

机构信息

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

Department of Pediatrics, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

出版信息

Asian J Endosc Surg. 2022 Oct;15(4):836-840. doi: 10.1111/ases.13081. Epub 2022 May 17.

Abstract

We herein report a 13-year-old boy with a chief complaint of abdominal pain and a palpable mass. Contrast-enhanced computed tomography (CT) scan showed an abdominal bulky tumor involving the ascending colon causing severe stenosis, with multiple abdominal lymph node metastases detected by positron emission tomography (PET)-CT. Laparoscopic radical resection with right hemicolectomy and lymph node dissection was planned. The bulky tumor was dissected from the retroperitoneum and resected en bloc with the right-side colon and omentum. The preoperatively detected metastatic lymph nodes were resected along with the tumor. A 6-cm longitudinal umbilical incision was made, and the huge tumor was removed, with functional end-to-end anastomosis performed for intestinal reconstruction. The pathological diagnosis was Burkitt-like lymphoma with 11q aberration. The postoperative course was uneventful. Laparoscopy-assisted extirpation is feasible for pediatric solid tumors involving other organs, but indications and procedures should be carefully determined based on preoperative imaging, intraoperative findings and surgeon's skills.

摘要

我们在此报告一例 13 岁男孩,主要诉腹痛和可触及肿块。增强 CT 扫描显示腹部肿块累及升结肠导致严重狭窄,并通过正电子发射断层扫描(PET-CT)检测到多个腹部淋巴结转移。计划行腹腔镜根治性右半结肠切除术和淋巴结清扫术。从腹膜后分离出巨大肿瘤,并整块切除右侧结肠和大网膜。沿肿瘤切除术前检测到的转移性淋巴结。行 6cm 长的脐部切口,取出巨大肿瘤,行肠重建的功能端端吻合。病理诊断为 11q 异常的伯基特样淋巴瘤。术后过程顺利。腹腔镜辅助切除适用于累及其他器官的儿科实体瘤,但应根据术前影像学、术中发现和外科医生的技术仔细确定适应证和手术步骤。

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