切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2021, Vol. 14 ›› Issue (04): 241 -244. doi: 10.3877/cma.j.issn.1674-6899.2021.04.012

所属专题: 经典病例

病例报告 上一篇    下一篇

腹腔镜手术治疗结肠癌肝转移并盆腔转移一例
向俊西 1, 杨魁 2, 王光辉 2, 李龙 3, 张月浪 4, 吴胤英 5, 杨威 1, 佘军军 2, 刘青光 1, 姚英民 1, 郭成 1 , ( )   
  1. 1. 710061 西安交通大学第一附属医院肝胆外科
    2. 710061 西安交通大学第一附属医院胃肠外科
    3. 710061 西安交通大学第一附属医院妇科
    4. 710061 西安交通大学第一附属医院影像科
    5. 710061 西安交通大学第一附属医院肿瘤内科
  • 收稿日期:2021-07-28 出版日期:2021-10-08
  • 通信作者: 郭成

Laparoscopic surgery for colon cancer liver metastasis and pelvic metastasis: a case report

Junxi Xiang 1, Kui Yang 2, Guanghui Wang 2, Long Li 3, Yuelang Zhang 4, Yinying Wu 5, Wei Yang 1, Junjun She 2, Qingguang Liu 1, Yingmin Yao 1, Cheng Guo 1 , ( )   

  1. 1. First Affiliated Hospital of Xi′an Jiaotong University, Department of; Hepatobiliary Surgery, Xi′an 710061, China
    2. Gastrointestinal Surgery, Xi′an 710061, China
    3. Gynaecology, Xi′an 710061, China
    4. Radiology, Xi′an 710061, China
    5. Oncology, Xi′an 710061, China
  • Received:2021-07-28 Published:2021-10-08
  • Corresponding author: Cheng Guo
目的

总结腹腔镜同期手术治疗结肠癌肝转移并盆腔转移的技术体会,探讨其在治疗此类疾病中的安全性及可行性。

方法

回顾性分析2021年6月西安交通大学第一附属医院1例结肠癌肝转移并盆腔转移患者的临床资料及诊疗过程。

结果

患者接受同期腹腔镜右半结肠切除、肝转移癌切除、全子宫及双侧附件切除,均顺利实现R0切除,总手术时间330 min,术中出血量100 ml,术后恢复顺利,辅助腹腔热灌注化学药物治疗。病理结果提示:结肠溃疡型中分化腺癌,侵及子宫肌壁深肌层及双侧卵巢组织、宫颈,肝组织内有中分化腺癌浸润,肠周(2/30个)淋巴结有癌转移。患者术后1个月复查腹部CT,肿瘤标志物未见明显异常,目前继续严密随访中。

结论

腹腔镜同期手术对于结肠癌肝转移并盆腔转移的治疗是安全、可行的,同时具有创伤小、恢复快、切口美观等优点,多学科诊疗模式对于提高患者临床获益具有重要作用,值得推广。

Objective

To summarize the experience of laparoscopic concurrent surgery in the treatment of colon cancer liver metastasis and pelvic metastasis, and to explore its safety and feasibility in the treatment process.

Methods

A retrospective analysis of the clinical data and diagnosis and treatment process of a patient with liver metastasis from colon cancer and pelvic metastasis in the First Affiliated Hospital of Xi′an Jiaotong University in Jun. 2021.

Results

The patient received simultaneous laparoscopic resection of the right colon for liver metastatic cancer, complete hysterectomy and bilateral adnexectomy, and R0 resection was successfully achieved. The total operative time was 330 min, and the bleeding was 100 ml. Peritoneal hyperthermic perfusion chemotherapy was assisted. Pathological results showed that colonic ulcerative moderately differentiated adenocarcinoma invaded the deep myometrium of the uterine wall and bilateral ovarian cervix, infiltrated in liver tissue, and metastatic in periintestinal lymph nodes (2/30). The abdominal CT and tumor markers showed no abnormalities one month after the operation. At present, the patient is continuing to follow up closely.

Conclusions

Simultaneous laparoscopic surgery is safe and feasible for the treatment of colon cancer liver metastases and pelvic metastases. It also has the advantages of less trauma, fast recovery, and beautiful incisions. The MDT mode plays an important role in improving the clinical benefits of patients and is worthy of promotion.

图1 术前腹腔、盆腔CT
图2 术中探查及主要操作步骤
图3 结肠癌灶病理检查 (HE, 100×)
1
中华人民共和国国家卫生健康委员会.中国结直肠癌诊疗规范(2020年版)[J]. 中华外科杂志202058(8):561-585.
2
Siegel RL, Miller KD, Goding SA, et al. Colorectal cancer statistics, 2020[J]. CA Cancer J Clin, 202070(3):145-164.
3
Biasco G,,Derenzini E,,Grazi G,et al. Treatment of hepatic metastases from colorectal cancer: many doubts, some certainties[J]. Cancer Treatment Reviews, 2006, 32(3):214-228.
4
刘亚江,唐小滨,冯金华. 聚焦超声联合化学药物治疗方案治疗晚期结肠癌伴盆腔转移患者的有效性分析[J]. 医学理论与实践202033(13):2132-2134.
5
Pawlik TM, Choti MA. Surgical therapy for colorectal metastases to the liver[J]. J Gastrointest Surg200711(8):1057-1077.
6
Dexiang Z, Li R, Ye W, et al. Outcome of patients with colorectal liver metastasis: analysis of 1,613 consecutive cases[J]. Ann Surg Oncol201219(9):2860-2868.
7
Blazer DG, Kishi Y, Maru DM, et al. Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases[J]. J Clin Oncol200826(33):5344-5351.
8
Margonis GA, Buettner S, Andreatos N, et al.Prognostic factors change over time after hepatectomy for colorectal liver metastases: a multi-institutional, international analysis of 1099 patients[J]. Ann Surg2019269(6):1129-1137.
9
中国医师协会外科医师分会,中华医学会外科分会胃肠外科学组,中华医学会外科分会结直肠外科学组,等. 中国结直肠癌肝转移诊断和综合治疗指南(2020版)[J]. 临床肝胆病杂志202137(3):543-553.
10
Turrini O, Viret F, Guiramand J, et al. Strategies for the treatment of synchronous liver metastasis[J]. Eur J Surg Oncol200733(6):735-740.
11
Hajibandeh S, Hajibandeh S, Sultana A, et al. Simultaneous versus staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases: a meta-analysis of outcomes and clinical characteristics[J]. Int J Colorectal Dis202035(9):1629-1650.
12
Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings[J]. Ann Surg2012255(3):405-414.
13
Fretland AA, Dagenborg VJ, Bjornelv GMW, et al. Laparoscopic versus open resection for colorectal liver metastases: the oslo-comet randomized controlled trial[J]. Ann Surg2018267(2):199-207.
14
Aghayan DL, Kazaryan AM, Dagenborg VJ, et al. Long-term oncologic outcomes after laparoscopic versus open resection for colorectal liver metastases : a randomized trial[J]. Ann Intern Med2021174(2):175-182.
15
郑民华,马君俊.单孔腹腔镜结肠癌根治术的规范化操作技术要点[J/CD]. 中华腔镜外科杂志(电子版)201710(6):330-334.
16
周嘉敏,王鲁.结直肠癌肝转移的外科治疗[J]. 肝胆外科杂志202129(1):1-5.
17
Look Hong NJ, Gagliardi AR, Bronskill SE, et al. Multidisciplinary cancer conferences: exploring obstacles and facilitators to their implementation[J]. J Oncol Pract20106(2):61-68.
18
郑民华,马君俊.腹腔镜右半结肠完整结肠系膜切除术[J/CD]. 中华腔镜外科杂志(电子版)20158(1):1-4.
[1] 吴丰信, 吴英光, 俞建雄, 王胜. 腹腔镜辅助保留幽门胃部分切除术治疗早期胃中部癌近期疗效分析[J]. 中华普通外科学文献(电子版), 2021, 15(05): 326-330.
[2] 周仕海, 陈宏, 张静, 雒洪志, 冯春在, 孙浩, 钟思全. 结直肠肿瘤经自然腔道取出标本手术67例分析[J]. 中华普通外科学文献(电子版), 2021, 15(05): 340-343.
[3] 陈松, 唐宇哲, 付猛, 苏博兴, 刘宇保, 肖博, 胡卫国, 李建兴. 良性输尿管狭窄的治疗:90例单中心回顾分析[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(04): 313-316.
[4] 张昊, 姜元军, 刘涛. 顺行性腹腔镜下腹股沟淋巴结清扫术14例经验总结[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(04): 317-320.
[5] 刘广旭, 刘涛. 3D腹腔镜与2D腹腔镜在肾部分切除术中的对比研究[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(04): 330-333.
[6] 术者:张树彬 助手:邢中强 段佳悦 李昂 指导老师:刘建华 剪辑:徐晨. 健侧先行原位右半肝+全尾状叶切除的腹腔镜肝门部胆管癌根治术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[7] 褚薛慧. 腹腔镜肝右后叶切除术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[8] 卢攀 刘心怡 李坚 陈龙 张伟. 经脐单孔腹腔镜左半肝切除术[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 0-.
[9] 张硕, 杨军, 顾元龙. 腹腔镜胆囊切除术致胆道损伤的危险因素及处理[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 470-473.
[10] 吴志明, 黄洪军, 孟兴成, 葛佳皓, 沈丽青, 胡常恩, 虞洪. ERAS理念在腹腔镜胆总管切开取石一期缝合术中的应用[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 474-478.
[11] 丁天龙, 谷保红, 李雪梅, 胡继科, 张凡, 冯泽东, 马斌, 王琛, 陈昊. "脱衣法"腹腔镜胆囊切除术的应用[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 498-501.
[12] 王峰杰, 陈焕伟, 刘颖, 雷秋成, 宁燕文. 腹腔镜胰体尾切除手术入路及安全性[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 506-509.
[13] 李国林, 王秀, 陈桂婵, 邱逸红. 腹腔镜胰十二指肠切除术围手术期标准化管理[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 510-513.
[14] 李涛, 吐尔洪江·吐逊, 沙地克·阿帕尔, 白磊, 曹峻, 何翼彪, 王智鹏, 赵晋明. 全腹腔镜活体供肝右半肝切取术一例并文献复习[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 514-518.
[15] 蓝炘, 朴成林, 安峰铎, 谈明坤, 司振铎, 吴蔚, 赵娜, 冷建军. 3D腹腔镜与2D腹腔镜下肝癌切除术的短期疗效比较[J]. 中华临床医师杂志(电子版), 2021, 15(05): 327-330.
阅读次数
全文


摘要