内容紹介
Summary
We report a case of transverse colon cancer resected by laparoscopic partial colectomy, followed by open gastrectomy. A man in his 70s was diagnosed with transverse colon cancer. He had a history of open gastrectomy for gastric lymphoma; thus, postoperative adhesions were expected in the upper abdomen. We performed a laparoscopic partial colectomy with gentle adhesiotomy, without injury. After preparation of the marginal vessels, blood flow towards the planned anastomotic line was confirmed by infrared observation after venous injection of indocyanine green. However, the initially planned oral anastomotic line did not show a blood supply; therefore, the anastomotic line was altered to a site of sufficient blood flow. In post-laparotomy cases, delicate handling and careful adhesiotomy are necessary in the laparoscopic approach due to the possibility of severe intraoperative injury resulting in conversion to open surgery. Furthermore, blood flow confirmation by fluorescence angiography is recommended in cases in which anatomical alterations might have occurred due to the previous operation.
要旨
開腹胃癌手術の既往を有する横行結腸癌症例に対し,腹腔鏡下結腸部分切除術を施行した。症例は70歳台,男性。20年以上前に胃悪性リンパ腫に対する開腹幽門側胃切除術・Billroth Ⅰ再建手術の既往があった。腹腔鏡下に慎重に癒着を剝離し,他臓器損傷なく対象臓器の剝離授動を行った。適切なリンパ節郭清,予定された脈管処理を行った後,腸管切離吻合予定線をインドシアニングリーン(ICG)静注下の蛍光血流観察にて確認した。当初の口側切離予定線に血流不全を認め,切離吻合部位を血流良好部に変更した。開腹手術既往のある腹腔鏡下手術の際は癒着による解剖の誤認を防ぐべく,慎重に必要かつ十分な癒着剝離を要する。高度癒着症例の再手術において,ICGによる血流評価は想定外の血流不全を回避し得る可能性が示唆された。
目次
We report a case of transverse colon cancer resected by laparoscopic partial colectomy, followed by open gastrectomy. A man in his 70s was diagnosed with transverse colon cancer. He had a history of open gastrectomy for gastric lymphoma; thus, postoperative adhesions were expected in the upper abdomen. We performed a laparoscopic partial colectomy with gentle adhesiotomy, without injury. After preparation of the marginal vessels, blood flow towards the planned anastomotic line was confirmed by infrared observation after venous injection of indocyanine green. However, the initially planned oral anastomotic line did not show a blood supply; therefore, the anastomotic line was altered to a site of sufficient blood flow. In post-laparotomy cases, delicate handling and careful adhesiotomy are necessary in the laparoscopic approach due to the possibility of severe intraoperative injury resulting in conversion to open surgery. Furthermore, blood flow confirmation by fluorescence angiography is recommended in cases in which anatomical alterations might have occurred due to the previous operation.
要旨
開腹胃癌手術の既往を有する横行結腸癌症例に対し,腹腔鏡下結腸部分切除術を施行した。症例は70歳台,男性。20年以上前に胃悪性リンパ腫に対する開腹幽門側胃切除術・Billroth Ⅰ再建手術の既往があった。腹腔鏡下に慎重に癒着を剝離し,他臓器損傷なく対象臓器の剝離授動を行った。適切なリンパ節郭清,予定された脈管処理を行った後,腸管切離吻合予定線をインドシアニングリーン(ICG)静注下の蛍光血流観察にて確認した。当初の口側切離予定線に血流不全を認め,切離吻合部位を血流良好部に変更した。開腹手術既往のある腹腔鏡下手術の際は癒着による解剖の誤認を防ぐべく,慎重に必要かつ十分な癒着剝離を要する。高度癒着症例の再手術において,ICGによる血流評価は想定外の血流不全を回避し得る可能性が示唆された。