Nakai Nozomu, Yamaguchi Tomohiro, Kinugasa Yusuke, Shiomi Akio, Tomioka Hiroyuki, Kagawa Hiroyasu, Yamakawa Yushi, Sato Sumito
Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Int Surg. 2015 Mar;100(3):423-7. doi: 10.9738/INTSURG-D-13-00255.1.
Crossed-fused renal ectopia (CFRE) is a very rare congenital renal malformation. This condition comprises several anatomic anomalies, including unilateral ureteral intersection of the midline, anteriorly-placed renal pelvises, and aberrant renal blood vessels, all of which increase the difficulty of colectomy. This report describes a case of laparoscopic sigmoidectomy with sufficient lymphadenectomy for a patient with sigmoid colon cancer and left-sided L-shaped CFRE. Preoperative computed tomography demonstrated that the origin of the inferior mesenteric artery (IMA) was free from anomalies and that the tumor did not invade surrounding organs. Therefore, we planned conventional laparoscopic sigmoid colectomy with D3 lymphadenectomy. Division of IMA at its origin and anterior colon resection was successfully performed by careful mobilization of the mesocolon to avoid exposing the retroperitoneal organs. To our knowledge, this is the first case report of laparoscopic colectomy for a patient with CFRE. Sufficient preoperative assessment of anatomic anomalies enabled successful surgery.
交叉融合型肾异位(CFRE)是一种非常罕见的先天性肾畸形。这种情况包括几种解剖学异常,包括单侧输尿管在中线交叉、肾盂前置以及肾血管异常,所有这些都增加了结肠切除术的难度。本报告描述了一例为患有乙状结肠癌和左侧L形CFRE的患者进行的腹腔镜乙状结肠切除术及充分的淋巴结清扫术。术前计算机断层扫描显示肠系膜下动脉(IMA)起源无异常,肿瘤未侵犯周围器官。因此,我们计划进行常规腹腔镜乙状结肠切除术及D3淋巴结清扫术。通过仔细游离结肠系膜以避免暴露腹膜后器官,成功地在IMA起始部进行了离断并切除了前部结肠。据我们所知,这是首例关于CFRE患者腹腔镜结肠切除术的病例报告。对解剖学异常进行充分的术前评估使得手术得以成功进行。