S状結腸切除術の既往がある生体腎移植ドナーに対して後腹膜鏡下左腎採取術を施行した1例

A case of retroperitoneoscopic left nephrectomy for a living kidney transplant donor with a history of sigmoid colectomy

◆要旨：患者は68歳，女性．生体腎移植ドナーとして後腹膜鏡下左腎採取術を施行した．S状結腸癌に対してD3リンパ節郭清を伴う腹腔鏡下S状結腸切除術の既往があり，左側結腸間膜が後腹膜から剝離・授動されているため今回の後腹膜鏡下左腎採取術への影響が懸念された．しかし実際はS状結腸切除術の影響は少なく，当科における手術既往のない生体腎移植ドナーと比べて短時間で手術終了した．これはS状結腸切除術，腎採取術の両方で内視鏡手術特有の拡大視効果により正確な層で剝離がなされ，Gerota筋膜が温存されたことが大きく，両手術で操作腔が干渉せずに後腹膜鏡下左腎採取術で癒着の影響が抑えられたことが最大の要因と考える．

　The patient was a 68-year-old woman. Laparoscopic sigmoidectomy with D3 lymph node dissection was performed previously for sigmoid colon cancer, and left retroperitoneoscopic donor nephrectomy was performed subsequently as a living-donor kidney transplant donor. In sigmoidectomy with lymph node dissection, the left-sided mesentery is dissected from the retroperitoneum; therefore, a history of a previous operation may be a concern in retroperitoneal kidney surgery. However, in this case, in both the sigmoidectomy and retroperitoneal laparoscopic donor nephrectomy, the correct layer was dissected owing to the magnifying effect peculiar to endoscopic surgery, and Gerota's fascia on the ventral side of the kidney was preserved. Therefore, it was considered that the effect of the previous sigmoidectomy was minimal, and the subsequent donor nephrectomy required less operation time and resulted in less bleeding volume than those expected in living-donor kidney transplant donors with no history of surgery.