馬蹄腎を合併したS状結腸癌に対して腹腔鏡下S状結腸切除術を施行した1例

A case of laparoscopic resection of sigmoid colon cancer associated with a horseshoe kidney

◆要旨：患者は56歳，女性．便潜血陽性を指摘され，精査の結果，S状結腸癌と診断された．CT検査で，馬蹄腎および右総腸骨動脈から馬蹄腎峡部に流入する腎動脈の破格を指摘された．術前所見からcSM, N0, P0, H0, M0と診断し，腹腔鏡下S状結腸切除術，D3郭清を施行した．術中所見では下腸間膜動脈，左尿管，左卵巣動静脈は馬蹄腎峡部の前面を走行していた．また，下腸間膜動脈の起始部は馬蹄腎峡部の頭側に存在し，これを根部にて切離した．馬蹄腎を合併した左側結腸切除の場合，尿管走行，腸骨動脈からの腎動脈の破格に留意する必要がある．馬蹄腎を合併した大腸癌に対する腹腔鏡下手術の報告はほかに1例の報告を認めるのみであり，文献的考察を加え報告する．

　We report a case of laparoscopic resection of sigmoid colon cancer associated with horseshoe kidney. A 56-year-old female was referred to our hospital for close examination because her fecal occult blood test was positive. Primary sigmoid colon cancer was diagnosed by colonoscopy. Computed Tomography revealed a horseshoe kidney with an aberrant renal artery that supplied the renal isthmus from the right common iliac artery. Laparoscopic sigmoidectomy with inferior mesenteric artery root nodal dissection was performed. At the operation, the inferior mesenteric artery, the left ureter and the left ovarian vessels passed in front of the isthmus. The root of inferior mesenteric artery was identified on the temporal side of the renal isthmus, and was divided. Only one case of laparoscopic resection of sigmoid colon cancer associated with horseshoe kidney has been reported in the literature.