大動脈後左腎静脈を伴った左腎癌

A case of left renal cell carcinoma with retroaortic left renal vein

患者は71歳，女性。肉眼的血尿を主訴に，近医より紹介受診。精査にて，左腎癌cT1bN0M1（肺転移）と診断した。また，腹部造影CTでは大動脈後左腎静脈を伴っていた。腹腔鏡下根治的左腎摘除術（経腹アプローチ）を施行した。術中，左腎静脈内に腫瘍栓を認めた。病理結果は淡明細胞癌，G2＞G3，INFα，pT3bであった。

We report a rare case of left renal cell carcinoma with retroaortic left renal vein in 71-year-old woman,which was safely treated by laparoscopic surgery. Because preoperative CT scan showed retroaortic left renal vein,we chose transperitoneal approach for laparoscopic radical nephrectomy. In laparoscopic radical nephrectomy with venous anomalies,transperitoneal approach is reasonable because of wide working space and flexible operative procedure. We emphasized the importance of preoperative understanding of the renal vascular anatomy and anomaly,by preoperative imaging examination such as CT scan.