Maeda Yoshiaki, Shinohara Toshiki, Nagatsu Akihisa, Futakawa Noriaki, Hamada Tomonori
Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan.
Asian J Endosc Surg. 2014 Nov;7(4):317-9. doi: 10.1111/ases.12123.
We herein report a case of laparoscopic high anterior resection with D3 lymph node dissection for rectosigmoid colon cancer with a horseshoe kidney. A 65-year-old Japanese man referred to our hospital for rectosigmoid colon cancer was found to have a horseshoe kidney on a CT scan. On 3-D CT angiography, an aberrant renal artery was visualized feeding the renal isthmus that arises from the aorta just below the root of the inferior mesenteric artery (IMA). Laparoscopic anterior rectal resection with D3 lymph node dissection was performed. During the operation, the IMA, left ureter, left gonadal vessels and hypogastric nerve plexus could be seen passing over the horseshoe kidney isthmus. With the aid of preoperative 3-D CT angiography, the root of the IMA was identified on the temporal side of the isthmus and divided safely just above the hypogastric nerve. As a horseshoe kidney is often accompanied by aberrant renal arteries and/or abnormal running of the ureter, 3-D CT angiography is useful for determining the location of these structures and avoiding intraoperative injury.
我们在此报告一例腹腔镜下高位前切除术联合D3淋巴结清扫治疗伴有马蹄肾的乙状结肠癌病例。一名因乙状结肠癌转诊至我院的65岁日本男性患者，在CT扫描中发现有马蹄肾。在三维CT血管造影上，可见一条异常肾动脉为肾峡部供血，该肾峡部起自肠系膜下动脉（IMA）根部下方的主动脉。实施了腹腔镜直肠前切除术联合D3淋巴结清扫。手术过程中，可见IMA、左输尿管、左生殖血管和下腹神经丛从马蹄肾峡部上方经过。借助术前三维CT血管造影，在峡部的颞侧确定了IMA根部，并在腹下神经上方安全地进行了离断。由于马蹄肾常伴有异常肾动脉和/或输尿管走行异常，三维CT血管造影有助于确定这些结构的位置并避免术中损伤。
