83岁女性升结肠黏液腺癌腹腔镜根治性右半结肠切除术1例报告

Laparoscopic Radical Right Hemicolectomy for Ascending Colon Mucinous Adenocarcinoma in an 83-Year-Old Woman: A Case Report

摘要: 目的：本文完整报道1例接受腹腔镜根治性右半结肠切除术的老年升结肠粘液腺癌患者的临床表现、诊断方法、外科治疗、病理特征和临床结果，并结合现有文献分析其临床病理特征和标准化治疗策略。方法：对扬州大学附属医院收治的一名83岁女性升结肠黏液腺癌患者的临床资料进行回顾性分析。系统回顾并总结了患者的术前结肠镜检查、腹部和胸部计算机断层扫描(CT)结果、术中探查记录、术后病理切片、免疫组化染色结果、手术方案及出院后随访资料。结果：患者主诉“右上腹间断疼痛10年，加重1个月”入院；电子结肠镜活检确诊升结肠中–低分化黏液腺癌，术前胸腹部CT提示升结肠壁不规则增厚、周围脂肪间隙模糊伴微小淋巴结显影，未见远处转移征象。完善全身术前评估后实施腹腔镜根治性右半结肠切除术联合肠系膜淋巴结清扫术、腹腔粘连松解术，术中证实肿瘤位于升结肠中段、侵透浆膜层，无肝脏、腹膜远处转移。术后病理回报升结肠溃疡型中分化腺癌伴局部黏液腺癌成分，瘤体大小6.5 × 6.0 × 0.7 cm，癌组织穿透固有肌层浸润浆膜下纤维脂肪组织，无脉管癌栓、神经侵犯；清扫肠周淋巴结25枚、肠系膜上动脉旁淋巴结3枚，全部未见癌转移(0/28)。免疫组化结果：MLH1 (−)、PMS2 (−)、MSH2 (+)、MSH6 (+)、CDH17 (+)、CDX2 (+)、HER2 (1+)、Ki-67约85%阳性，最终病理分期pT3N0M0 (IIA期)。患者术后恢复顺利，无严重手术并发症，按计划出院。结论：升结肠黏液腺癌具有不同于传统结直肠腺癌的独特临床病理表型。针对局限期升结肠黏液腺癌，腹腔镜根治性右半结肠切除术安全可行，高龄患者亦可收获满意短期预后；术后完整病理检测与免疫组化分型，对肿瘤精准分期、预后判断、个体化后续治疗均具有不可替代的临床价值。

Abstract: Objective: To summarize clinical manifestations, diagnostic methods, surgical management, pathological characteristics and clinical outcomes of an elderly patient with ascending colon mucinous adenocarcinoma receiving laparoscopic radical right hemicolectomy, and analyze its clinicopathological features and standardized treatment strategies combined with published literature. Methods: The clinical data of an 83-year-old female patient diagnosed with ascending colon mucinous adenocarcinoma in the Affiliated Hospital of Yangzhou University were retrospectively analyzed. Preoperative colonoscopy, abdominal and thoracic computed tomography (CT), intraoperative exploration records, postoperative pathological slides, immunohistochemical staining results, surgical plan and post-discharge follow-up data were systematically reviewed and summarized. Results: The patient suffered from “intermittent right upper quadrant abdominal pain for 10 years with acute exacerbation in the past month”. Colonoscopic biopsy confirmed moderately to poorly differentiated mucinous adenocarcinoma of ascending colon. Preoperative CT scan revealed irregular thickening of ascending colon wall with peripheral adipose space blur and minor inflammatory lymph nodes, with no distant metastasis signs. After comprehensive preoperative assessment, laparoscopic radical right hemicolectomy with mesenteric lymphadenectomy and intraperitoneal adhesion lysis was performed successfully. During the operation, it was confirmed that the tumor was located in the middle segment of the ascending colon, penetrating the serosal layer, with no distant metastasis to the liver or peritoneum. Pathological examination showed ulcerative moderately differentiated adenocarcinoma with focal mucinous adenocarcinoma components, tumor dimension was 6.5 × 6.0 × 0.7 cm; carcinoma invaded through muscularis propria into subserosal fibro-adipose tissue, without lymphovascular or perineural invasion. A total of 25 lymph nodes around the intestine and 3 lymph nodes beside the superior mesenteric artery were dissected, and all were negative for metastatic carcinoma (0/28). Immunohistochemistry: MLH1 (−), PMS2 (−), MSH2 (+), MSH6 (+), CDH17 (+), CDX2 (+), HER2 (1+), Ki-67 index about 85%. Final pathological stage was pT3N0M0 (Stage IIA). The patient had smooth postoperative recovery without severe surgical complications and was discharged on schedule. Conclusion: Mucinous adenocarcinoma of ascending colon has unique clinicopathological phenotypes different from conventional colorectal adenocarcinoma. Laparoscopic radical right hemicolectomy is safe and curative for localized lesions even in advanced-age patients. Complete pathological detection and immunohistochemical profiling are essential for accurate tumor staging, prognostic stratification and postoperative individualized treatment decision-making.