Treatment of rare giant malignant tumor of stomach

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Stomach cancer is not uncommon in clinical, but also a huge stomach malignant tumor in two different types, and occupy the import and export


Stomach cancer is not uncommon in clinical, but also a huge stomach malignant tumor in two different types, and occupy the import and export of the stomach is relatively rare, here to share with you this rare case.

With women, 78 years old, because of recurrent severe anemia in January hematochezia, "visits to the local hospital for gastroscopy and CT examination. The results showed that there was a giant gastric stromal tumor with ulceration in the gastric fundus, a protruded mass in the antrum and a size of 4*3.5cm. Upper abdominal CT enhancement: "gastric body and fundus of the stomach of the huge changes in the position of about 10*10cm, accompanied by calcification changes, considering the possibility of interstitial tumors, antral mucosal thickening. Patients with gastric fundus and proximal gastric stromal tumors. There are two different types of malignant tumors, especially in the proximal gastric cardia and antrum, and the operation risk is very high. After the removal of various doctors by Qiu Weihua outpatient income.

After hospitalization, our team carefully discuss the disease: the elderly patients -- 78 years old, two stomach huge tumor hemorrhage in patients with severe anemia, hemoglobin 60.0g/L (only normal minimum value is 110g/L), and tumor patients caused by eating difficulties in January, poor nutritional status of the body. The anatomy of the stomach from near to far consists of cardia and gastric fundus, gastric body, antrum and pylorus and gastric cardia is at the upper part of the stomach and esophagus connected part (gastric antrum entrance), is connected through the distal stomach, pylorus and duodenal (gastric outlet). So if the simultaneous resection of the two different types of malignant tumors, to total gastrectomy, gastric cancer and must go beyond the conventional dissection, sweeping all first stations and second stations of perigastric lymph nodes, including first, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12 the lymph node, and an artificial gastric jejunum reconstruction. It is more difficult to stomach cancer clung to the spleen and spleen supply arteries and veins, radical resection is likely to also must remove the spleen, leading to further expand the surgical trauma, and could lead to a possible hypercoagulable state and fulminant infection after operation. Therefore, the surgical treatment of this rare tumor has a high requirement on the basic physiological conditions, organ function and nutritional status of the patients.

We repeatedly discussed the operation plan, the risk and the families of repeated communication operation, we guide in precise surgery, the patient developed a plan carefully for the detailed operation plan, including the surgical approach, organ disconnection order, the cleaning scope, vascular treatment. At the same time, preoperative preparation, including nutritional support, psychological counseling, etc..

In August 23, 2014, Dr. Qiu Weihua performed in Ruijin Hospital of total gastrectomy and +D2 lymph node dissection + esophageal jejunal Roux-en-Y anastomosis + cholecystectomy, intraoperative transection of the duodenum, the lesser curvature of the stomach to free the lower esophageal transection, posterior gastric vessels, then from the stomach free cut off all short gastric vessels to the lower end of the esophagus. Very fine from close to the stomach spleen and spleen vascular tumors, will be close to the splenic tumor from the splenic capsule removed, retained the spleen, and successfully opened the cleaning channel tenth and 11 groups of lymph node dissection in gastric surgery, all week first and second station + fourteenth and 15 lymph nodes dissection, intraoperative blood transfusion was 800ml anemia before operation.

In the fast track surgery under the guidance of the concept, we not only through the intraoperative gastric tube indwelling nasal diameter only 3.3mm spiral nasointestinal tube in the jejunum, distal jejunum more than an end to side anastomosis of jejunum about 40cm. After we pass this slender spiral nasointestinal tube, early enteral nutrition, 2 weeks of rehabilitation of patients after operation, without any complications including fever, infection.

Postoperative paraffin pathology and immunohistochemistry showed that gastric mucosa showed a mass, diameter 10cm, mass dark gray section, nature is hard, to highlight the serosa, gastric juice side to see a polypoid mass, size 8*4cm, pathological diagnosis of gastric adenocarcinoma II with mucinous adenocarcinoma and signet ring cancer cell components (elevated), at the bottom of gastric gastrointestinal stromal tumors, high risk.

The risk of this case lies in elderly patients with severe anemia, stomach, "entrance" and "exit" have large tumors, and tumor close to the spleen, to radical resection range, and the need to expand the corresponding surgical dissection. Through accurate preoperative evaluation, precise surgical planning, fine operation and postoperative nursing care, the patients were treated with complete resection of two huge tumors and spleen preservation.


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