3D-CT angiographyが腹腔鏡手術に有用であった腸回転異常を伴う盲腸癌の1例

Utility of 3-D radiological vascular simulation of laparoscopic colectomy for advanced cecal cancer in a patient with intestinal malrotation : A case report and literature review

◆要旨：症例は79歳，男性．貧血の精査目的に大腸内視鏡検査を施行したが挿入困難であったため，後日ダブルバルーン内視鏡を行い盲腸癌と診断した．身長168cm，体重93.8kg，BMI 33.7．腹部CT検査で，小腸は腹腔内右側，回盲部は左側へ変位し，SMV rotation signを認めた．腸回転異常症に合併した盲腸癌の診断で，腹腔鏡下に回盲部切除術を施行した．手術所見はmalrotation typeの腸回転異常症で，肥満により腸間膜脂肪織が肥厚していたが，3D-CT angiographyをもとに上腸間膜動静脈から回結腸動静脈を露出し，安全に血管切離，リンパ節郭清を施行しえた．近年，腸回転異常症を伴った大腸癌症例に対しても腹腔鏡手術を行う報告が増えてきている．今回，腸回転異常症を伴う盲腸癌に対する腹腔鏡手術において，術前3D-CT angiographyが非常に有用であった．

　A 79-year-old male presenting with melena was diagnosed with cecal cancer by double-balloon colonoscopy. He was not able to have a whole colon examination due to insertion difficulty during conventional colonoscopy one year ago. His body mass index was 33.7. Abdominal computed tomography showed that the entire small intestine was located at the right side of the abdomen, and the colon was at the left side. SMV rotation sign was also observed, indicating a diagnosis of intestinal malrotation. Laparoscopic ileocecal resection was performed. During the procedure, 3-D virtual angiography helped us to perform lymph node dissection and vessel ligation accurately and safely. Post-operative course was uneventful and he was discharged from our hospital 8 days after the surgery. Recently, laparoscopic treatments for colon cancer in patients with intestinal malrotation have been reported. However, this procedure is considered to be highly difficult due to anatomical characteristics. Preoperative 3D-CT angiography may be helpful to overcome such difficulties.