PDF(Pubmed)
Abstract：
BACKGROUND Reversed intestinal malrotation is an extremely rare disease, with an incidence of 1 in 250 000. In Japan, application of robotic-assisted colorectal cancer surgery is expected to increase. There are no reports of robot-assisted surgery for cecal cancer with reversed intestinal malrotation. CASE REPORT An 84-year-old Japanese man with epigastric pain and abdominal distention was referred to our hospital\'s Department of Gastroenterology for thorough examination. Colonoscopy revealed a semicircumferential type 2 tumor in the cecum and ascending colon. Gastrografin contrast study showed that the large intestine was entirely on the patient\'s right side and the small intestine was shifted to the left side. Contrast-enhanced computed tomography revealed enlarged lymph nodes near the tumor, and masses were observed at the liver, which were believed to be metastases. Following examination, reversed intestinal malrotation and concurrent cecal cancer was diagnosed. The patient was referred to our department for surgery and underwent robot-assisted ileocecal resection with D3 lymphadenectomy. The postoperative course was favorable, and patient was discharged on the sixth postoperative day, without complications. According to the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma 9th edition, the pathological diagnosis was pT4b (ileum), pN1b, cM1a (H1 [grade A]), and pStage IVa cancer. After considering tumor stage and patient\'s overall condition in consultation with his family, we decided against palliative systemic therapy. The patient was provided with best supportive care. CONCLUSIONS Robot-assisted surgery might be useful in manipulation of the dissection of adhesions, owing to its capacity for high-resolution 3-dimensional imaging and forceps manipulation, using articulated functions.
摘要：
背景技术逆转肠旋转不良是一种极其罕见的疾病,发病率为250000中的1。在日本,机器人辅助结直肠癌手术的应用有望增加。没有关于机器人辅助手术治疗盲肠癌伴有肠旋转不良的报道。病例报告一名84岁的日本男子上腹痛和腹胀被转诊到我院消化内科进行彻底检查。结肠镜检查显示盲肠和升结肠有半2型肿瘤。Gastrografin对比研究显示，大肠完全在患者的右侧，小肠向左侧移动。对比增强计算机断层扫描显示肿瘤附近淋巴结肿大，在肝脏观察到肿块，被认为是转移。检查后,逆转肠旋转不良和并发盲肠癌被诊断。患者被转诊到我们的部门进行手术，并接受了机器人辅助的回盲肠切除术和D3淋巴结切除术。术后病程良好，患者在术后第六天出院，没有并发症。根据日本结肠直肠分类，阑尾,和肛门癌第9版，病理诊断为pT4b（回肠），pN1b,cM1a(H1[等级A]),和IVa期癌症。在与家人协商考虑肿瘤分期和患者的整体状况后，我们决定不进行姑息性全身治疗.为患者提供了最佳的支持性护理。结论机器人辅助手术可能是有用的操作的剥离的粘连，由于其高分辨率三维成像和镊子操作的能力，使用明确的功能。
