Jin Hiroyuki, Morohashi Hajime, Sato Kentaro, Umetsu Satoko, Yoshida Tatsuya, Wakasa Yusuke, Ichinohe Daichi, Ogasawara Hiroshi, Hasebe Tatsuya, Miura Takuya, Sakamoto Yoshiyuki, Hakamada Kenichi
Dept. of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2016 Nov;43(12):2292-2294.
Lateral lymph node dissection(LLND)for locally advanced lower rectal cancer is the standard treatment procedure in Japan. We performed LLND with an extraperitoneal approach. Recently, we introduced laparoscopic surgery for locally advanced rectal cancer and laparoscopic LLND. We performed laparoscopic LLND in a patient havinglower rectal cancer with lateral lymph node metastasis that was detected via preoperative imaging.
The patient was a woman in her 50s who experienced melena and visited a physician. Colonoscopy revealed a tumor in the lower rectum and computed tomography showed lateral lymph node swelling and liver metastasis. The patient was referred to our institution and she was diagnosed with lower rectal cancer having lateral lymph node and synchronous liver metastases. We performed laparoscopic abdominoperineal resection and laparoscopic LLND. The operatingtime was 260 min, and the blood loss was 60g.
The magnification of laparoscopy enables precision in the surgical operation of the narrow pelvis during lymph node dissection, allowingautonomic nerve preservation. Therefore, laparoscopic LLND is a helpful procedure in the treatment of locally advanced rectal cancer with a lateral lymph node metastasis.
在日本，局部晚期低位直肠癌的侧方淋巴结清扫术（LLND）是标准治疗方法。我们采用腹膜外入路进行LLND。最近，我们将腹腔镜手术引入局部晚期直肠癌及腹腔镜LLND治疗中。我们为一名经术前影像学检查发现有低位直肠癌伴侧方淋巴结转移的患者实施了腹腔镜LLND。
患者为一名50多岁的女性，出现黑便并就医。结肠镜检查发现低位直肠有肿瘤，计算机断层扫描显示侧方淋巴结肿大及肝转移。患者转诊至我院，被诊断为低位直肠癌伴侧方淋巴结及同时性肝转移。我们实施了腹腔镜腹会阴联合切除术及腹腔镜LLND。手术时间为260分钟，失血量为60克。
腹腔镜的放大作用使在狭窄骨盆进行淋巴结清扫时的手术操作更加精确，有利于保留自主神经。因此，腹腔镜LLND是治疗伴有侧方淋巴结转移的局部晚期直肠癌的一种有效方法。
