完全内臓逆位に合併した直腸癌に対しreduced port surgeryで腹腔鏡下超低位前方切除を施行した1例

Laparoscopy assisted low anterior resection with reduced port method for situs inversus totalis and mesenterium commune : a case report

◆要旨：患者は71歳，女性．肛門縁から4cmの直腸後壁側に示指頭大の小病変を認めた．造影CT検査で内臓逆位を認めたが，リンパ節腫大や遠隔転移は指摘されなかった．cT2，N0，M0，StageⅠ直腸癌の診断で，完全内臓逆位症例であったが，当科のreduced port surgery（RPS）適応基準を満たしており，RPSで腹腔鏡下超低位前方切除を施行した．通常の腹腔鏡下超低位前方切除術と変わらない手術時間，出血量で施行できた．術後合併症はなく経過し，退院となった．通常の腹腔鏡下手術と同じクオリティでRPSにて根治術を遂行しうる施設においては，内臓逆位症例であっても慎重にRPSでの根治術を試みてもよいものと考えられた．

We report a patient with situs inversus totalis and mesenterium commune treated by laparoscopy assisted low anterior resection （LAR） with reduced ports procedure for lower rectal cancer. A 71-year-old woman was referred to our hospital for surgical therapy. She was diagnosed as lower rectal cancer, 4cm above the anal verge, accompanied with situs inversus totalis. We performed super LAR by laparoscopic surgery with reduced-port technique, successfully. We considered that reduced-port laparoscopic approach is feasible in case of situs inversus totalis and mesenteium commune. This is the first case report that described the patient with rectal cancer accompanied with situs inversus totalis and mesenterium commune treated by reduced port laparoscopic surgery.