腹腔鏡下大腸切除におけるいわゆるpersistent descending mesocolon 13例の検討

Laparoscopic colectomy for persistent descending mesocolon : an experience of 13 patients

◆要旨：当院で行った下行結腸から直腸までの腹腔鏡下大腸切除543例のうち，persistent descending mesocolon （PDM）と判断したS状結腸固定異常を13例（2.4％）に認めた．PDMは左側結腸間膜が短縮し，S状結腸は小腸間膜や右側骨盤壁と癒着していること，下腸間膜動脈の分枝が放射状に分岐していることなどが特徴的であり，S状結腸が蛇行しさらに下行結腸と癒着するlong-S型と，それがなく直線的に下行結腸から移行するshort-S型に分類可能であった．術中は特に下行結腸の辺縁動脈を損傷しないよう注意を払う必要があった．PDMを伴う症例では通常のS状結腸と比較すると手術時間が長く，出血量は多かったが，術後在院日数に差はなく，腹腔鏡下手術でも安全に施行可能であった．

We performed laparoscopic colectomy in 543 patients for descending colon to rectal cancer. We experienced 13 patients with abnormality of sigmoid colon fixation which is so-called persistent descending mesocolon（PDM）. Character of PDM is adhesion between the sigmoid colon to the mesentery and pelvic wall. PDM can be classified into long-S type and short-S type with or without adhesion to the descending colon. Careful dissection is necessary to prevent injury of the marginal vessels of the descending colon because this mesocolon is shortened. Comparing PDM and normal sigmoid colon, there was a significant difference in operating time and blood loss. However, there were no differences in postoperative hospital stay. Laparoscopic colectomy is safe even for patients with PDM.