腹腔镜胃大部切除术和乙状结肠切除术联合经自然腔道取标本手术(NOSES)治疗同时性胃癌和乙状结肠癌:1例病例报告

Laparoscopic Subtotal Gastrectomy and Sigmoidectomy Combined With Natural Orifice Specimen Extraction Surgery (NOSES) for Synchronous Gastric Cancer and Sigmoid Colon Cancer: A Case Report.

作者信息

Zhu Qingshun, Yu Lei, Zhu Guangxu, Jiao Xuguang, Li Bowen, Qu Jianjun

机构信息

Department of Clinical Medical College, Weifang Medical University, Weifang, China.

Department of General Surgery, The First Affiliated Hospital of Weifang Medical College, Weifang People's Hospital, Weifang, China.

出版信息

Front Surg. 2022 Jun 8;9:907288. doi: 10.3389/fsurg.2022.907288. eCollection 2022.

Abstract

BACKGROUND

Gastric cancer and colon cancer are rarely seen in clinic, but there are still related reports. For gastric cancer and simultaneous colon cancer, surgical resection is the main treatment. Traditional surgery requires an incision from xiphoid process to pubic symphysis. With the progress of minimally invasive technology, laparoscopic surgery is also used in the treatment of gastric cancer, but also in the abdominal incision to remove specimens and in vitro anastomosis of digestive tract. Taking specimens through the natural cavity as a new surgical method can not only reduce the abdominal incision, but also reduce the occurrence of wound-related complications. Here, we report a patient with gastric cancer and colon cancer who was treated in our hospital.

CASE SUMMARY

We report a series of patients with gastric cancer and colon cancer. upper abdominal pain was treated in our hospital for 6 months. electronic gastroscopy showed large irregular ulcers on the lesser curvature of the gastric antrum and biopsy showed poorly differentiated adenocarcinoma of the gastric antrum. The enhanced CT of abdomen and pelvis showed irregular thickening of gastric antrum wall, irregular thickening of sigmoid colon wall and no obvious enlarged lymph nodes around. Further electronic enteroscopy showed that the sigmoid colon showed cauliflower protuberance, the intestinal cavity was slightly narrow, the intestinal wall was stiff, and the biopsy pathology showed moderately differentiated adenocarcinoma of the sigmoid colon. No obvious abnormality was found in serological tumor indexes. We diagnosed gastric cancer with sigmoid colon cancer and the patient received Laparoscopic subtotal gastrectomy and sigmoidectomy combined with natural orifice specimen extraction surgery. At present, 12 months after operation, no clear tumor recurrence was found in the metastasis.

CONCLUSION

We should improve the understanding of gastric cancer and sigmoid cancer and combine examination with pathology to avoid misdiagnosis as metastatic cancer. Laparoscopic subtotal gastrectomy should be performed for tumors with no serosa invasion, body mass index <30 and tumor diameter <6.5 cm. Sigmoidectomy combined with natural nostril sampling is feasible.

摘要

背景

胃癌和结肠癌在临床上较为少见,但仍有相关报道。对于胃癌合并同时性结肠癌,手术切除是主要治疗方法。传统手术需从剑突至耻骨联合做切口。随着微创技术的进步,腹腔镜手术也用于胃癌治疗,但仍需在腹部做切口取出标本并进行消化道体外吻合。经自然腔道取标本作为一种新的手术方式,不仅能减少腹部切口,还能降低伤口相关并发症的发生。在此,我们报道1例在我院接受治疗的胃癌合并结肠癌患者。

病例总结

我们报道1例系列胃癌合并结肠癌患者。因上腹部疼痛在我院治疗6个月。电子胃镜显示胃窦小弯侧有巨大不规则溃疡,活检显示为胃窦低分化腺癌。腹部及盆腔增强CT显示胃窦壁不规则增厚,乙状结肠壁不规则增厚,周围未见明显肿大淋巴结。进一步电子肠镜显示乙状结肠呈菜花状隆起,肠腔稍狭窄,肠壁僵硬,活检病理显示为乙状结肠中分化腺癌。血清学肿瘤指标未发现明显异常。我们诊断为胃癌合并乙状结肠癌,患者接受了腹腔镜胃大部切除术、乙状结肠切除术联合经自然腔道取标本手术。目前,术后12个月,未见明确肿瘤复发转移。

结论

应提高对胃癌和乙状结肠癌的认识,结合检查与病理以避免误诊为转移性癌。对于无浆膜侵犯、体重指数<30且肿瘤直径<6.5 cm的肿瘤应行腹腔镜胃大部切除术。乙状结肠切除术联合经自然腔道取标本是可行的。

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