腹腔镜内侧径路法乙状结肠癌切除术

目的 探讨腹腔镜内侧径路法治疗乙状结肠癌的手术方法。方法 分析2001年4月～2002年11月施行的13例腹腔镜乙状结肠癌切除术患者的手术方法，采用内侧径路法，即先处理肠系膜根部及中枢侧淋巴、血管，后处理病变肠管。结果 13例患者均成功完成腹腔镜手术，平均手术时间130min，术中平均出血30mL，平均术后住院日7d，无手术并发症和死亡发生，随诊6～21个月，未发现局部或全身肿瘤复发、转移。结论 只要严格掌握手术指征，合理选择手术方式，腹腔镜内侧径路法治疗结肠肿瘤是安全、有效的。     

Melanotic Xp11-associated tumor of the sigmoid colon:A case report

BACKGROUND Melanotic Xp11-associated tumors are rare mesenchymal-derived tumors. So far,most primary melanotic Xp11-associated tumors have been reported in the kidney, and reports of this tumor in the gastrointestinal tract are rare.CASE SUMMARY Here we describe the case of a 25-year-old woman who presented with a melanotic Xp11-associated tumor in the sigmoid colon. Colonoscopy revealed a large mucosal bulge in the sigmoid colon, approximately 32 cm inside the anus.The surface was rough with local erosion. The tumor was brittle on biopsy and bled easily. Computed tomography revealed thickening of the rectal wall with edema. Postoperative pathology indicated the likelihood of a perivascular epithelioid cell tumor. Histologically, the tumor comprised plump epithelioid cells with abundant clear to lightly eosinophilic cytoplasm and round nuclei arranged in an alveolar or trabecular pattern. The tumor cells were strongly positive for HMB-45, Melan-A, Cathepsin K, and TFE3 but negative for vimentin,smooth muscle actin, S100 protein, CD10, CK20, and desmin. The tumor cells had a low Ki-67 labeling index(approximately 2%). Fluorescence in situ hybridization revealed TFE3 fracture. Based on these histologic and immunohistochemical features, a diagnosis of melanotic Xp11-associated tumor of the sigmoid colon was made.CONCLUSION In summary, we report the clinicopathological features of a primary tumor that is extremely rare in the sigmoid colon and review the clinicopathological characteristics of melanotic Xp11-associated tumors, compatible with the very rare tumor termed "melanotic Xp11 translocation renal cancer" in all aspects.     

两种腹腔镜手术方案在乙状结肠癌患者中的疗效对比

目的对比传统腹腔镜乙状结肠癌根治术与腹部无切口经直肠取出标本腹腔镜手术的近期疗效。方法以2015年1月-2016年12月于该院拟实施腹腔镜辅助乙状结肠癌根治手术的患者中选出34例实施腹部无切口经直肠取出标本腹腔镜乙状结肠癌根治术的患者作为腹部无切口组。以1∶2的配对方式选择同期内年龄、性别一致,体质指数(BMI)相近的实施腹腔镜辅助乙状结肠癌根治手术的患者68例作为对照组。对比两种腹腔镜手术方案的手术时间、手术出血量、术后排气时间、术后疼痛评分、手术并发症、术后住院时间、附加镇痛处理情况、肠管切除长度、近远端切缘、肿瘤大小、淋巴结清扫数目和p TNM分期。结果腹部无切口组乙状结肠癌患者的手术时间、手术出血量明显高于对照组,腹部无切口组乙状结肠癌患者的术后排气时间、术后清醒时疼痛评分、术后第1天的疼痛评分明显低于对照组,差异有统计学意义(P0.05);两组乙状结肠癌患者的肠管切除长度、远近端切缘、肿瘤大小、淋巴结清扫数目和p TNM分期差异无统计学意义(P0.05)。腹部无切口组随访5~8个月,平均6个月;对照组随访6~9个月,平均7个月,均未发现肿瘤局部复发及远处转移。结论相比于传统腹腔镜手术,腹部无切口经直肠取出标本腹腔镜乙状结肠癌根治术可以明显降低患者的疼痛程度,缩短术后排气时间,肿瘤根治效果相近。     

Case of intra‐abdominal spindle cell tumor after laparoscopic resection of sigmoid colon cancer

We herein report a rare case of a patient who developed a spindle cell tumor at the inferior mesenteric artery clipping site. A 58‐year‐old man underwent laparoscopy‐assisted sigmoid colectomy for sigmoid colon cancer. As follow‐up, CT scans were performed every 6 months after the primary surgery. At the 1‐year CT, an nodular soft tissue density mass measuring 54 mm in diameter was found in the mesentery. Although we initially suspected locoregional recurrence of the colon cancer resected 1 year earlier, PET‐CT showed that the tumor was unrelated to the previous cancer. During the subsequent laparotomy, the mass appeared to originate from the inferior mesenteric artery clipping site, and it adhered to the jejunum and the left ureter. We completely resected the tumor and part of the jejunum, which we separated from the abdominal aorta and left ureter. The tumor was histologically diagnosed of a spindle cell tumor. The patient has been free from recurrence since the surgery more than 4.5 years ago. Preoperative PET‐CT was helpful in ruling out local recurrence of colon cancer, which might have made palliative care a better option than surgical resection.     

Laparoscopic reduced port surgery for schwannoma of the sigmoid colon: A case report

A 74‐year‐old woman who developed schwannoma of the sigmoid colon was referred to our hospital for colonography to determine the cause of her stool occult blood. Colonoscopy revealed a submucosal tumor, which measured 3 cm in diameter, in the sigmoid colon. Endoscopic ultrasonography revealed a low echoic, homogeneous and demarcated submucosal tumor that continued into the fourth layer of the colonic wall. Gastrointestinal stromal, myogenic or neurogenic tumor was suspected, and thus, laparoscopic sigmoidectomy was carried out. We used two ports during the operation, a SILS Port in the umbilical region and a 12‐mm port in the right lower abdominal wall, and performed sigmoidectomy with D2 lymph node dissection. Histological findings revealed spindle‐like tumor cells with multiform nuclei. The tumor was diagnosed by immunostaining as benign schwannoma of the sigmoid colon. The conventional surgical treatment for schwannoma of the digestive tract is partial resection, but if preoperative diagnosis is unknown, radical resection with lymphadenectomy is acceptable for submucosal tumors in the digestive tract. In this case, laparoscopic reduced port surgery using only one or two ports may be more feasible and beneficial with regard to cosmesis and reduced postoperative pain than conventional laparoscopic colectomy.     

内置水囊法超声诊断直肠和乙状结肠小肿瘤的价值

目的探讨内置水囊法超声诊断直肠和乙状结肠小肿瘤的价值。方法122例患者经直肠和乙状结肠内置水囊,并注入水300~500ml,在其充盈后进行超声检查。结果内置水囊下直肠和乙状结肠的小肿瘤为低回声,超声诊断结果与手术和病理对照,超声定位诊断符合率占84%,定性诊断符合率占88%。结论内置水囊法超声显像对直肠和乙状结肠小肿瘤有较高检出率,术前内置水囊法超声显像有一定价值。     

结肠体表超声投影及肿瘤定位诊断

目的：通过滞肠后结怕体表投影超声观察,并与常规经腹超声对结肠肿瘤定位诊断结果对照研究,分析超声对结肠肿瘤的定位诊断及误诊原因,方法：91例灌肠后超声检查,其中21例肠道恶性肿瘤为常规经腹超声（未灌肠）首诊发现,作对照研究。结果：升结肠及联系人结肠位置相对固定,位于侧腹。乙状结肠变化较大,13％达左肋缘及左肋间,1％达右肋缘,10％与回盲部紧邻;横结肠2％达左下腹与乙状结肠及降结肠相邻;结肠杆菌2％,脾曲1％达腋中线等4－5肋间。21例常规经腹超声首诊发现的结肠肿瘤中,3例部位误诊。结论：结肠肿瘤部位误诊与肠道分布变化有关,了解肠道肿瘤为化及其与邻近脏器的关系。有助于提高诊断率。     

Sigmoid volvulus after laparoscopic surgery for sigmoid colon cancer

We report the first case of sigmoid volvulus after laparoscopic surgery for sigmoid colon cancer. The patient is a 75‐year‐old man who presented with the sudden onset of severe abdominal pain. He had undergone laparoscopic sigmoidectomy for cancer 2 years before presentation. CT scan showed a distended sigmoid colon with a mesenteric twist, or “whirl sign.” Colonoscopy showed a mucosal spiral and luminal stenosis with dilated sigmoid colon distally and ischemic mucosa. The diagnosis of ischemic colonic necrosis due to sigmoid volvulus was established. Resection of the necrotic sigmoid colon was performed and a descending colon stoma was created. A long remnant sigmoid colon and chronic constipation may contribute to the development of sigmoid volvulus after laparoscopic sigmoidectomy. Prompt diagnosis is essential for adequate treatment, and colonoscopy aids in the diagnosis of ischemic changes in patients without definitive findings of a gangrenous colon.     

Retrograde colon intussusception in an adult due to adenoma: Treatment by combined laparoscopic and endoscopic approach

This report describes the case of a young patient who underwent laparoscopic surgery to reduce for a retrograde intussusception of the sigmoid‐descending colon caused by adenoma of the sigmoid colon. A 36‐year‐old woman visited our hospital, complaining primarily of vomiting and abdominal pain. Abdominal CT scan showed the typical finding of intussusception. An emergency colonoscopy revealed that the invaginated colon with a polypoid mass was protruding into the descending colon. A gastrografin enema showed the invaginated bowel segment at the descending colon. We performed endoscopic polypectomy and then hand‐assisted laparoscopic reduction. The pathological finding showed tubular adenoma. Laparoscopy is a diagnostic or therapeutic tool for selected cases of adult intussusception. Benign tumor is one of the causes of intussusception in adults and a good indication for laparoscopic surgery.     

结肠镜、多层螺旋CT在肠梗阻病因诊断中的应用价值

目的探讨结肠镜、多层螺旋CT在肠梗阻病因诊断中的应用价值。方法回顾性分析146例经腹部平片、手术证实肠梗阻患者的结肠镜、多层螺旋CT资料。结果146例肠梗阻.结肠梗阻68例，小肠梗阻73例，未明确5例。结肠镜检查73例：其中结肠肿瘤41例，结肠息肉6例，结肠套叠8例，乙状结肠扭转2例，回肠末段肿瘤3例，未见异常13例。多层螺旋CT检查78例：其中小肠粪块22例，粪石2例，肠腔外淋巴瘤4例，肠系膜血栓形成1例，小肠肿瘤26例，原因未明23例。治疗情况：保守治疗30例，结肠镜下乙状结肠扭转复位2例，肠套叠空气灌肠复位3例，内镜下结肠息肉高频电切除术6例，手术治疗105例。死亡6例，康复140例。结论应用结肠镜、多层螺旋CT检查有助于更好作出肠梗阻的病因诊断。     

老年人乙状结肠穿孔的诊治（附35例报道）

目的：探讨老年人乙状结肠穿孔的临床特点和诊治经验。方法：回顾性分析35例老年人乙状结肠穿孔患者的临床资料。结果：本组35例中,肿瘤性穿孔9例,非肿瘤性穿孔26例。所有患者均行急诊剖腹探查术,术后因感染性休克或多器官功能衰竭死亡13例（37.1%）,存活22例（62.9%）,术后再发穿孔行二次手术5例,伤口感染8例,伤口裂开行二期缝合2例。结论：老年人群乙状结肠穿孔有时缺乏特异性临床表现,综合分析病史、体征及辅助检查,准确判断手术指征和手术治疗是改善预后的关键。     

Laparoscopic surgery for sigmoid colon cancer after multiple operations including urinary diversion with Indiana pouch: A case report

A 73‐year‐old man with lower abdominal pain was diagnosed at our hospital with sigmoid colon cancer. He had previously undergone radical cystectomy with Indiana pouch construction and gastrectomy to treat bladder cancer and gastric cancer, respectively. We performed a laparoscopic Hartmann's operation with Japanese D3 lymph node dissection. We observed severe adhesion in the abdominal cavity; adhesions between the urostomy and sigmoid colon were particularly severe. The tumor had invaded to the distal rectum, which had adhered to the pubic bone and the previously reconstructed urinary pouch. By performing careful and persistent laparoscopic dissection, we completed the operation without damaging the urostomy and with no remnant tumor tissue (R0). The postoperative course was uneventful, and the patient was doing well with no evidence of cancer recurrence 1 year after surgery.     

Dermoid perforation of the colon

A case report of an ovarian dermoid tumor perforating the sigmoid colon in a pregnant woman is presented. Various complications of dermoid perforation are discussed.     

超声内镜对结直肠黏膜下病变的诊断价值

目的探讨超声内镜(EUS)在结直肠黏膜下病变诊断和治疗中的作用。方法对结直肠黏膜下病变进行EUS检查。根据黏膜下病灶的起源层次,部分患者接受深挖活检、超声内镜引导下细针穿刺吸取活检术(EUS-FNA)、内镜下治疗或外科手术。回顾性分析EUS诊断结果与临床病理的相关性。结果 EUS检查的74例患者中,诊断神经内分泌肿瘤28例(均位于直肠);脂肪瘤15例(其中位于回盲部4例、横结肠1例、升结肠8例、乙状结肠2例);直肠间质瘤2例(固有肌层和黏膜肌层各1例);外压性改变14例(卵巢肿瘤9例,淋巴结2例,盆腔肿瘤3例);囊肿5例(横结肠4例、升结肠1例);气囊肿1例;乙状结肠子宫内膜异位3例;直肠周边恶性肿瘤侵犯4例;肠道淋巴瘤2例。所有病灶均接受深挖活检、EUS-FNA、内镜下治疗或外科手术。最终病理和EUS诊断符合率为68/74(91.9%),其中2例EUS考虑直肠类癌最后病理确诊为黏膜肌层来源的平滑肌瘤。1例考虑脂肪瘤最终确诊为肠道淋巴瘤。2例考虑直肠周边恶性肿瘤最终为炎性包块,1例考虑子宫内膜异位症最终诊断为直肠癌。结论 EUS能清晰地显示消化道各层结构,能清楚显示结直肠黏膜下病变的大小、起源及其与相邻结构的关系,并且能较精确地判断各种病变的性质,进而指导结直肠黏膜下病变的治疗。     

Obstructing giant colonic diverticulum

We report the second case of an obstructing true colonic diverticulum. Of the 103 cases of giant sigmoid diverticulum found in the literature, 13% have been reported as true giant sigmoid diverticulum, ie, containing all layers of the colonic wall. Our 75-year-old patient had clinical symptoms for only 6 months, and endoscopy revealed an almost totally obstructing mass 20 cm from the anus. Surgical resection of the sigmoid colon with a primary anastomosis resolved all of the patient's obstructive symptoms. A flap-valve mechanism was the cause of this true giant colonic diverticulum. Microscopic examination of the diverticulum wall revealed all normal layers of colon wall.     

Laparoscopic repair of an incarcerated inguinal hernia containing the sigmoid colon with a colonoscope

Here, we report the first case of laparoscopic surgery to repair an incarcerated colonoscope in an inguinal hernia containing the sigmoid colon. After colonoscopy was performed on a 74-year-old man with positive fecal occult blood test results, the colonoscope could not be withdrawn. A bulge consistent with an incarcerated colonoscope was found on examination of the patient's left inguinal area. Computed tomography revealed and led to the diagnosis of an incarcerated colonoscope in the sigmoid colon within the inguinal hernia. After confirmation during emergency laparoscopic surgery, the incarcerated sigmoid colon was reduced, and the colonoscope was removed under radiographic and laparoscopic guidance. No ischemic changes or serosal injuries were observed, averting the need for resection. A transabdominal preperitoneal approach with a mesh was then used to repair the inguinal hernia laparoscopically. The patient's postoperative recovery was uneventful, and no recurrence was observed at the 1-year follow-up.     

Natural history of sigmoid colon cancer: report of a patient observed for 4 years

We report a case of sigmoid colon cancer that was left untreated for a period of 4 years, because the patient declined treatment. A 59-year-old man was found to have an early carcinoma of the sigmoid colon measuring approximately 12 mm in diameter. The lesion, initially a flat cancer, increased in height and became sessile 4 months later. Subsequently, the central portion of the lesion became ulcerated, leaving an elevated ring along its periphery. The lesion eventually evolved into an ulcerated, invasive cancer. This sequence has not been observed with colonoscopy before.     

乙状结肠膀胱扩大术治疗神经源性急迫性尿失禁的临床研究

目的探讨乙状结肠膀胱扩大术治疗顽固性神经源性急迫性尿失禁伴便秘的疗效。方法 16例患者经尿动力学检查为急迫性尿失禁,且术前均未发现肾积水和膀胱输尿管返流,行乙状结肠膀胱扩大术。结果术后随访3～24个月,均未见肾积水、膀胱输尿管返流和生化异常,便秘症状明显好转。所有患者能利用腹压辅助自行排尿及基本控尿,残余尿量10～40ml。结论乙状结肠膀胱扩大术治疗神经源性急迫性尿失禁能增加膀胱容量,降低膀胱压力,实现自主排尿;还能缓解便秘。     

Colorectal intussusception secondary to sigmoid carcinoma in an adult

Although intussusception is relatively common in children, it is clinically rare in adults A 54-year-old woman who presented with cramping abdominal pain and rectal bleeding was found to have sigmoid rectal intussusception secondary to adenomatous polyps of the sigmoid colon. Following confirmation of intussusception by CT scan, surgical resection was performed after manual reduction.     

Laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons: A case report

Persistent mesocolon is an embryological anomaly of the colon resulting from failure of the primitive dorsal mesocolon to fuse with the parietal peritoneum. We herein present a case of laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons and a right‐bound inferior mesenteric artery. Preoperative 3‐D CT demonstrated that the sigmoid colon had shifted to the right abdomen and was located under the ascending colon. Moreover, the inferior mesenteric artery and vein traveled toward the right abdomen accompanied by the mesentery of the descending colon. Adhesiolysis between the ascending and sigmoid colon was initially performed, and the sigmoid colon was placed in its normal position. The inferior mesenteric artery was then divided with lymph node dissection using a medial approach, and high anterior resection was completed. An understanding of the anatomical characteristics of persistent mesocolon is important to ensure safe laparoscopic surgery.