下肢肉腫の転移を疑い腹腔鏡下に16a2大動静脈間領域の腫瘤摘出術を施行した1例

Laparoscopic paraaortic lymph node dissection for diagnosis of metastatic sarcoma

◆要旨：患者は右大腿未分化肉腫術後6年目の20歳代の男性で，左肺と腹部大動脈周囲リンパ節大動静脈間（16a2int）領域にそれぞれ単発の腫瘤を指摘された．胸腔鏡下左肺上葉部分切除術に先行して腹腔鏡下腫瘤摘出術を施行した．左半側臥位，5ポート下にKocherの授動を行い，下大静脈から左腎静脈の前面までを広く露出させ，さらに頭側の大動脈と下大静脈の間で腫瘤を摘出した．病理組織学的にはschwannomaで，左肺結節は転移であった．右結腸と十二指腸を広く脱転することで16a2int領域への安全なアプローチが可能であった．

The patient was a 28-year-old man having undergone surgical treatment for undifferentiated round cell sarcoma of the right thigh 6 years ago. A solitary mass in the left lung and a swollen paraaortic lymph node （16a2int） were pointed out on computed tomography. Laparoscopic tumor resection was carried out prior to thoracoscopic left upper lung partial resection. In the left semi-lateral decubitus position, Kocher's maneuver was carried out through 5 ports, exposing a wide area from the inferior vena cava （IVC） to the frontal aspect of the left renal vein. The tumor was resected at the cranial region of the left renal vein between the aorta and the IVC, preserving the right celiac ganglia. Histopathological examination of the resected specimen was a schwannoma, and the left lung nodule was a metastasis. The lymph node 16a2int can be approached safely by mobilizing the right colon and duodenum extensively.