体腔内再建が有用であった左骨盤腎を伴う下行結腸癌の1例

Laparoscopic surgery with intracorporeal reconstruction for descending colon cancer with left pelvic kidney : A case report

◆要旨：症例は63歳，男性．下腹部不快感に対して下部消化管内視鏡検査を施行され，下行結腸癌を認めたため，手術目的で当科紹介となった．術前のCT検査で比較的稀な先天性異所性腎の一種である左骨盤腎の併存を認めた．手術は，腹腔鏡下下行結腸切除術を施行した．5ポートで内側アプローチを用いて手術を進めたが，左骨盤腎によって制限される骨盤内での操作において，左腎動静脈の副損傷に特に注意を要した．再建は，デルタ吻合を用いた体腔内再建を行うことで，必要最小限の結腸授動で再建が可能であった．術後経過は良好であり，10日目に退院した．

　A 63-year-old man presented with lower abdominal discomfort for which he underwent total colonoscopy. He was diagnosed with descending colon cancer and was referred to our department for colectomy. Preoperative computed tomography revealed a left pelvic kidney, which is a rare type of congenital ectopic kidney. We performed laparoscopic descending colectomy with intracorporeal reconstruction using delta-shaped anastomosis for successful reconstruction with minimal colonic mobilization. The surgery was performed using the medial approach with 5 ports. However, to prevent unexpected injury to the left renal vessels during pelvic manipulation that were restricted by the left pelvic kidney. Postoperative course was good, and the patient was discharged on postoperative day 10.