腸回転異常を伴った上行結腸癌に対して腹腔鏡補助下結腸術を施行した1例

Ascending colon cancer, with intestinal malrotation, resected by laparoscopy-assisted colectomy

◆要旨：腹腔鏡補助下に切除した腸回転異常を伴う上行結腸癌の1例を経験した．患者は84歳，男性．主訴は労作時呼吸苦．検血にて貧血があり，下部消化管内視鏡検査にて上行結腸に3型進行癌を認めた．腹部CT検査にて上腸間膜動静脈の位置関係が逆転しており，腸回転異常の存在が疑われた．腹腔鏡補助下に切除し，良好な経過で術後第10病日に退院となった．通常解剖とは異なり，結腸が後腹膜に固定されておらず，組織の緊張がかかりにくかった．血管解剖の相違点など，pitfallがあった．また，臍上に5cmの小切開を置いた際，結腸のほぼ全長と，郭清部位は体外に導出することが可能であった．厳密なD3郭清を必要としないリンパ節転移陰性例に対しては，まず臍周囲の小開腹にての手術を試みるのも選択肢の1つであると考えられた．

　A 84-year-old man admitted our hospital for general fatigue and anemia was diagnosed of type 3 cancer of the ascending colon, endoscopic examination. Computed tomography showed that the superior mesenteric vein（SMV）existed on the left side of the superior mesenteric artery, and he was suspected to have intestinal malrotation. The tumor existed in the pelvic space. We conducted laparoscopic assisted right colectomy with D2 lymph node dissection. Intra-operative finding revealed that he had intestinal malrotation and SMV rotation. The ileum and the ascending colon, with the root of its mesenterium, were able to be lifted out of the abdominal cavity through a five-cm laparotomy in the upper abdomen. Consequently, it was possible to proceed to resect the right colon with its lymph nodes from the 5 cm incision. Here, we reported a case of intestinal malrotation with ascending colon cancer, and discussed the preoperative diagnosis and points to be recognized for the operation procedure.