同じ4ポートで腹腔鏡下S状結腸切除および肝部分切除術を同時施行した結腸癌同時性肝転移の1例

Simultaneous resection of colon cancer and synchronous liver metastasis under complete laparoscopic surgery using the same 4 ports : A case report

◆要旨：患者は35歳，女性．健康診断にて便潜血陽性を指摘され，精査によりS状結腸癌と診断され当院に紹介となった．画像所見では，下部消化管内視鏡にてS状結腸に2型の腫瘍性病変を認め，腹部CTでは肝S3に周囲が淡く造影される40mm大の腫瘍性病変を認めた．S状結腸癌，肝転移の診断にて腹腔鏡下S状結腸切除術および腹腔鏡下肝S3部分切除術を施行した．

　手術は4ポートのみで完遂することができた．結腸・肝同時腹腔鏡下手術として4ポートで手術を完遂した報告例はなく，腫瘍の局在に応じた手技の工夫と定型化を行うことで安全に実施でき，体壁破壊を最小にできる低侵襲な手術法と考えられた．

　A 35-year-old-woman was referred to our hospital because of positive fecal occult blood test. Colonoscopy demonstrated a type 2 cancer in the sigmoid colon and abdominal CT detected a contrast-enhanced neoplastic lesion measuring 40mm in the S3 segment of the liver. We performed laparoscopic sigmoidectomy and partial resection of the S3 segment of the liver. We were able to accomplish the surgery laparoscopically using only 4 ports. There is no previous report of laparoscopic surgery that accomplished simultaneous resection of colon cancer and synchronous liver metastasis using only 4 ports. We could perform surgery safely by careful preoperative localization of the tumor, and it was thought that the surgical method was safe and minimally invasive.