腹部大動脈瘤ステントグラフト内挿術後に腹腔鏡補助下高位前方切除術を施行した直腸癌の1例

Case of rectum cancer and abdominal aortic aneurysm treated with endovascular aneurysm repair followed by laparoscopic assisted colectomy

◆要旨：患者は65歳，男性．便潜血陽性のため施行した大腸内視鏡検査にて直腸S状部に癌を認めた．病変はⅠs+Ⅱc病変で粘膜下層浸潤が疑われた．術前精査目的に施行した胸腹部造影CTでは，明らかなリンパ節転移や他臓器転移を疑う所見は認めなかったが，腎動脈下，総腸骨動脈分岐部直上に最大短径65mmの腹部大動脈瘤を認めた．腫瘍は早期癌と診断し，まず腹部大動脈瘤に対しステントグラフト内挿術を施行した．術後29日目，直腸S状部癌に対し腹腔鏡補助下高位前方切除術を施行した．消化器悪性腫瘍と腹部大動脈瘤の併存は時に経験することがあるが，ステントグラフト内挿術後に腹腔鏡下手術を施行することは有用であると考えられた．

The case is a 65-years-old man. On endoscopic examination, rectosigmoid cancer of typeⅠs+Ⅱc was diagnosed, and was found to invade into the lower mucosal layer. On preoperative computed tomography, no metastasis to the lymph node or other organs was noted. However, a 65-mm abdominal aortic aneurysm（AAA） was detected from the renal artery to the common iliac artery divergence department. Cancer was diagnosed at an early stage, and endovascular graft repair（EVAR） was first performed for AAA. Laparoscopic assisted colectomy（LAC） was safely performed 29 days after the first treatment. We conclude that LAC and EVAR are efficient treatments for synchronous gastrointestinal malignancy and AAA.