腸回転異常症を伴う結腸癌に腹腔鏡下切除を施行した2症例

Two cases of laparoscopic colectomy for colon cancer with intestinal malrotation

◆要旨：腸回転異常症を伴う結腸癌2例に対し腹腔鏡下手術を施行した．症例1は63歳，男性．盲腸側方発育型腫瘍（c-Stage 0）と上行結腸多発腺腫に対し腹腔鏡下右半結腸切除術・D1リンパ節郭清を施行した．腹腔内癒着は高度であった．症例2は81歳，男性．上行結腸癌c-Stage Iに対し，腹腔鏡下回盲部切除術・D2リンパ節郭清を施行した．癒着は中等度で，癒着剝離を行った後，回結腸動静脈を確認し，根部処理した．腸回転異常症は時に腹腔内の高度癒着を伴い，血管走行の変化も生じるため，癒着を剝離し正確な解剖を把握することが，腹腔鏡下手術において重要である．

Two cases of colon cancer with intestinal malrotation treated by laparoscopic colectomy are herein reported. Case1: A 63-year-old-man had a laterally spreading cecal tumor（cTis N0M0, c-Stage 0） and ascending polyps. Synchronous intestinal malrotation was preoperatively detected. Laparoscopic right hemi-colectomy and D1 lymph nodes dissection were performed. The greater omentum and total colon adhered severely, thus careful dissection and conformation of the anatomy were required. Case 2: A 81-year-old-man had a ascending colon cancer（cT2N0M0, c-Stage I） with intestinal malrotation and laparoscopic ileocecal resection and D2 lymph nodes dissection were performed. Intraperitoneal adhesion was relatively mild, and ileocolic vessels were cut at the roots. Intestinal malrotation causes unusual positioning of the blood vessels and intraperitoneal adhesion. Since severe intraperitoneal adhesion is occasionally observed in colon cancers with intestinal malrotation, careful dissection and anatomical conformation are important for laparoscopic colectomy.