横行結腸癌に対する尾側アプローチによる腹腔鏡下complete mesocolic excision

Laparoscopic complete mesocolic excision via caudal approach for transverse colon cancer

◆要旨：腹腔鏡下結腸切除術のなかでも，横行結腸切除は血管分岐の多彩なバリエーションや膵臓に近接した操作が必要となるため，高難度となる．筆者らは腹腔鏡下手術の利点である尾側からの拡大視野を活かし，間膜授動，血管切離，膵臓に沿った間膜切離をすべて尾側からの視野で行い，その手技を定型化している．特に，上腸間膜血管に沿って処理すべき血管の根部にアプローチすることと上腸間膜血管の左右で網囊を開放することで得られる横行結腸間膜と膵臓の立体的な理解が重要である．これまでに14例に行い，手術時間，出血量，術後在院日数の中央値は223分，5ml，8日で，Clavien-Dindo分類GradeIII以上の合併症は認めず，良好な成績が得られている．筆者らの手技の要点を報告する．

　Laparoscopic resection is most difficult to perform for transverse colon cancer among all colon cancers due to the variations of the vascular bifurcation and the need to manipulate close to the pancreas. We performed all procedures, including the mobilization of the mesocolon, division of the blood vessels, and transection of the transverse mesocolon along the pancreas using a magnified view from the caudal side, and standardized the procedure. In particular, an approach to the roots of the vessels to be divided along the superior mesenteric vessels and a three-dimensional understanding of the transverse mesocolon and the pancreas, which is obtained by opening the lesser sac on either side of the superior mesenteric vessels, are important. The median operative time, blood loss, and postoperative hospital stay of the 14 cases that underwent our procedures were 223 min, 5 ml, and 8 days, respectively, and there were no complications above Clavien?Dindo grade III. We reported the main points of the procedures.