腹腔鏡下に切除した全内臓逆位を伴ったS状結腸癌の1例

A case of laparoscopic sigmoidectomy for sigmoid colon cancer in a patient with situs inversus totalis

◆要旨：患者は50歳代，女性．健診の便潜血で陽性のため当院内科を受診した．大腸内視鏡検査でS状結腸癌と診断された．胸部X線，腹部CTで全内臓逆位であった．手術は腹腔鏡下S状結腸切除を施行した．SD junctionに近い部位で主幹動脈はS1であったので，下腸間膜動脈，上直腸動脈を温存したD3郭清のS状結腸切除術を施行した．内臓逆位に対する腹腔鏡下S状結腸切除術は開始当初視野展開で慣れるまで違和感を覚えたが，リンパ節郭清においては中枢方向からの順方向に郭清が可能で手技上問題なく安全に施行できる有用な術式と考える．

　A 50-year-old woman visited the internal medicine department in our hospital because of a positive fecal occult blood test. She was diagnosed with sigmoid colon cancer by colonoscopy. Chest X-ray film and abdominal CT scan revealed situs inversus totalis. Laparoscopic sigmoidectomy and lymph node dissection were performed. Since the tumor was located around the sigmoid-descending junction, the inferior mesenteric and supra rectal arteries were preserved. Lymph node dissection during laparoscopic surgery in sigmoid colon cancer patients with situs inversus totalis was a reasonable procedure because en bloc dissection from the proximal to distal lymph nodes was possible. Laparoscopic sigmoidectomy for colon cancer in a patient with situs inversus totalis is a feasible and safe procedure.