子宮浸潤を伴う直腸癌に対する腹腔鏡下手術において逆行性アプローチを用いた2例

Retrograde approach to vagina in laparoscopic surgery for rectal cancer with uterine invasion : two case reports

◆要旨：子宮を摘出するに際して尿管，直腸周囲，Douglas窩の癒着が強固な場合，前腟壁を切開して前腟円蓋を開放し，その後腟管の内腔面より逆行的に後腟壁を切開・開放する逆行性アプローチが有用なことがある．今回，術前のMRIにて直腸癌の子宮への浸潤が疑われ，腹腔鏡下に逆行性アプローチを用いて直腸とともに子宮を摘出した2症例を経験した．子宮への浸潤を伴う直腸癌に対する腹腔鏡下手術において，逆行性アプローチは有用な方法と思われた.

Retrograde approach to the vagina for hysterectomy has been reported to be useful in patients with severe adhesions due to pelvic inflammatory diseases or gross anatomic distortions due to large myomas and cervical myomas. We report two cases of rectal cancer with uterine invasion. In both cases, rectum and uterus were resected en block laparoscopically by using retrograde approach to vagina. This technique is considered to be useful in laparoscopic surgery for rectal cancer with uterine invasion.