Hisano Kyoko, Ueki Takashi, Kono Hiroshi, Ikenaga Naoki, Maeyama Ryo, Konomi Hiroyuki, Okido Masayuki, Yamashita Nobuaki, Motoshita Junichi, Ichimiya Hitoshi
Department of Surgery, Hamanomachi Hospital, Fukuoka, Japan.
Faculty of Radiological Technology, Hamanomachi Hospital, Fukuoka, Japan.
Asian J Endosc Surg. 2019 Jul;12(3):329-333. doi: 10.1111/ases.12637. Epub 2018 Aug 21.
Persistent mesocolon is an embryological anomaly of the colon resulting from failure of the primitive dorsal mesocolon to fuse with the parietal peritoneum. We herein present a case of laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons and a right-bound inferior mesenteric artery. Preoperative 3-D CT demonstrated that the sigmoid colon had shifted to the right abdomen and was located under the ascending colon. Moreover, the inferior mesenteric artery and vein traveled toward the right abdomen accompanied by the mesentery of the descending colon. Adhesiolysis between the ascending and sigmoid colon was initially performed, and the sigmoid colon was placed in its normal position. The inferior mesenteric artery was then divided with lymph node dissection using a medial approach, and high anterior resection was completed. An understanding of the anatomical characteristics of persistent mesocolon is important to ensure safe laparoscopic surgery.
持续性结肠系膜是由于原始背侧结肠系膜未能与壁腹膜融合而导致的结肠胚胎学异常。我们在此报告一例腹腔镜高位前切除术治疗三发性结直肠癌，该患者存在持续性升结肠系膜和降结肠系膜以及向右走行的肠系膜下动脉。术前三维CT显示乙状结肠已移位至右下腹并位于升结肠下方。此外，肠系膜下动脉和静脉伴随降结肠系膜向右下腹走行。首先进行升结肠与乙状结肠之间的粘连松解，将乙状结肠置于正常位置。然后采用内侧入路离断肠系膜下动脉并进行淋巴结清扫，完成高位前切除术。了解持续性结肠系膜的解剖特征对于确保腹腔镜手术安全至关重要。
