背景:哈特曼手术(HP)通常会导致骨盆间隙严重的术后粘连;因此,逆转Hartmann手术(RHP)是一项具有挑战性的手术。一种新型喷雾型防粘剂,AdSpray,据报道,在肝脏等三维领域是有用的。然而,没有关于其在HP中使用的报告。我们介绍了一例男性直肠癌患者,该患者接受了AdSpray腹腔镜HP以防止术后粘连。
方法:一名52岁男子出现黑便和便秘。
方法:结肠镜检查显示直肠乙状结肠有一个几乎阻塞性的II型肿瘤,组织病理学检查显示为中分化腺癌。增强腹部计算机断层扫描显示局部淋巴结稍肿大,但肿瘤周围无腹水,并且没有转移到肝脏或肺部。因此,我们诊断为临床分期T4aN1bM0直肠乙状结肠癌。术中,发现肝表面转移性肿瘤和口腔结肠中高度的瓣膜潴留.
方法:用AdSpray进行腹腔镜HP后,我们计划在1个月后进行腹腔镜RHP联合分期肝手术治疗结直肠癌同步肝转移。
结果:在骨盆或直肠残端周围未观察到术后炎性粘连,允许我们通过单切口腹腔镜手术从造口部位进行RHP,没有任何问题。RHP手术时间为80分钟,术后患者总体情况良好,术后第7天出院。
结论:在腹腔镜HP中,Adspray易于用于骨盆等三维领域,可有效预防术后炎性粘连。因此,RHP可能会降低风险,并作为微创手术进行更多。
BACKGROUND: Hartmann procedure (HP) often causes severe postoperative adhesions in the pelvic space; therefore, the reversal of Hartmann procedure (RHP) is a challenging surgery. A new spray-type antiadhesion agent, AdSpray, has been reported to be useful in three-dimensional fields such as the liver. However, there are no
reports of its use in HP. We present a
case of a male patient with rectal cancer who underwent laparoscopic HP with AdSpray to prevent postoperative adhesions.
METHODS: A 52-year-old man presented with melena and constipation.
METHODS: Colonoscopy revealed an almost obstructive type II tumor at the rectosigmoid colon, and histopathological examination revealed moderately differentiated adenocarcinoma. Enhanced abdominal computed tomography revealed slightly enlarged regional lymph nodes but no ascites around the tumor, and there was no metastasis to the liver or lungs. Therefore, we diagnosed clinical stage T4aN1bM0 rectosigmoid colon cancer. Intraoperatively, a metastatic tumor of the liver surface and a high degree of valve retention in the oral colon were identified.
METHODS: After performing laparoscopic HP with AdSpray, we scheduled a laparoscopic RHP with staged hepatic surgery for synchronous liver metastasis from colorectal cancer 1 month later.
RESULTS: No postoperative inflammatory adhesions were observed in the pelvis or around the rectal stump, allowing us to perform RHP by a single-incision laparoscopic surgery from the stoma site without any problem. The operation time for RHP was 80 minutes; the patient was in good general condition after the operation, and he was discharged on postoperative day 7.
CONCLUSIONS: In laparoscopic HP, Adspray was easy to use for three-dimensional fields such as the pelvis and effectively prevented postoperative inflammatory adhesions. Thus, RHP may become less risky and be performed more as a minimally invasive surgery.