完全内臓逆位症に合併した直腸癌に対する腹腔鏡下手術の経験

Laparoscopic surgery for rectal cancer in a patient with situs inversus totalis

◆要旨：患者は75歳，男性．23歳時，検診で内臓逆位症を指摘された．大腸内視鏡検査で隆起性病変を指摘されEMRを施行した．術後の病理組織学的検査で最深部は粘膜筋板から1,500μmまでの粘膜下層に癌の浸潤を認め，当科を紹介され受診となった．胸部単純X線検査で右胸心，腹部CT検査で内臓の逆位を認めたが，遠隔転移・リンパ節転移・随伴奇形を認めず，追加切除目的に腹腔鏡補助下高位前方切除術を施行した．通常より手術時間を要したが，正常人と同様に問題なく遂行できた．心血管系の随伴奇形・血管走行異常などの十分な術前評価と鏡面構造を踏まえて慎重な手術操作を行えば，内臓逆位症などの稀な疾患に対しても，腹腔鏡下手術は安全に施行できる術式と考える．

We reported a case of a patient with situs inversus totalis who underwent laparoscopic surgery for rectal cancer. A-63-year-old man was admitted to our hospital for further examination of rectal cancer. At 23-year-old, he was diagnosed as situs inversus totalis. Since pathological examination after endoscopic mucosal resection of rectal cancer revealed submucosal invasion, we performed laparoscopic surgery for rectal cancer. Laparoscopic assisted high anterior resection was performed with no serious complication, except for a complete mirror image. Laparoscopic surgery can be performed safely on patients with situs inversus totalis.