背景技术本报告描述了一名73岁的女性接受了腹部会阴切除术治疗的类风湿关节炎合并下直肠癌的情况。外侧区域淋巴结切除术,手助腹腔镜手术(HALS)进行部分肝切除术。最近,HALS已被证明可用于多器官切除。病例报告一名出现便血的73岁妇女被诊断患有低位直肠癌,并转诊至我们医院。该患者有类风湿性关节炎病史,正在服用口服非甾体抗炎药。经过进一步评估,该患者被诊断为IV期直肠癌,伴有转移性肝脏病变和右外侧淋巴结转移。所有病灶均采用HALS切除。创建了一个50毫米的纵向脐带切口,用作手进入部位,并在下腹部插入3个直径5mm的端口,进行右侧淋巴结清扫和腹部手术切除。HALS在上腹部进行,其中肝脏用于部分切除S6段。术后13天无并发症出院。结论在这种复杂的晚期直肠癌肝转移病例中,使用HALS手术方法被证明是可能的.类风湿关节炎的免疫调节治疗可能影响了该患者的预后。
BACKGROUND This report describes the
case of a 73-year-old woman treated for rheumatoid arthritis with lower rectal carcinoma who underwent abdominoperineal resection, lateral regional lymph node resection, and partial hepatectomy by hand-assisted laparoscopic surgery (HALS). More recently, HALS has proven to be useful in multiple organ resections.
CASE REPORT A 73-year-old woman who presented with hematochezia was diagnosed with lower rectal cancer and referred to our hospital. The patient had a history of rheumatoid arthritis and was taking oral nonsteroidal anti-inflammatory drugs. After further evaluation, the patient was diagnosed with stage IV rectal cancer with a metastatic liver lesion and a right lateral lymph node metastasis. All lesions were resected using HALS. A 50-mm longitudinal umbilical incision was created for use as a hand access site, and 3 ports with a diameter of 5 mm each were inserted into the lower abdomen to perform right lateral lymph node dissection and abdominoperineal resection. HALS was performed in the upper abdomen, where the liver was used to partially resect segment S6. The patient was discharged without complications 13 days after the operation. CONCLUSIONS In this complex
case of advanced rectal carcinoma with liver metastases, use of the HALS surgical method was shown to be possible. Immunomodulatory treatment for rheumatoid arthritis may have influenced the outcome for this patient.