左骨盤腎症例に対する腹腔鏡補助下S状結腸切除術の経験

Laparoscopy-assisted sigmoidectomy in a patient with a left pelvic kidney

◆要旨：骨盤腎は比較的稀な先天性の腎の位置異常である．骨盤腎症例では骨盤内に腎が存在するため，大腸の手術の際に大腸と大腸間膜の剝離操作による骨盤腎とその腎盂尿管や支配血管への損傷が危惧される．これらの損傷を回避するためには，安全な剝離層を選定することが大きな要点となる．腎筋膜前葉前面での剝離により，骨盤腎とその腎盂尿管や支配血管から大腸と大腸間膜を安全に剝離することが可能であった，骨盤腎を合併したS状結腸憩室症の手術症例について報告した．また，腎筋膜前葉の認識の確保には，腹腔鏡下手術が有用であると思われた．

　A pelvic kidney is a relatively rare congenital malpositioning of a kidney. In patients with a pelvic kidney, the kidney is located in the pelvic area, so in the event of colon surgery the concern is that dissection of the colon and mesentery will lead to the injury of the pelvic kidney, its renal pelvis, ureter and the blood vessels supplying those regions. Selecting a safe layer of dissection is crucial in order to avoid damage to these structures. As reported here, surgery was performed to treat sigmoid diverticulosis in a patient with a pelvic kidney. Dissection at the anterior surface of the renal fascia allowed safe dissection of the colon and mesentery from the pelvic kidney, its renal pelvis, ureter and the blood vessels supplying those tissues. In addition, laparoscopic surgery proved useful in ensuring recognition of the anterior renal fascia.