Kitaguchi Daichi, Nishizawa Yuji, Sasaki Takeshi, Tsukada Yuichiro, Kondo Akihiro, Hasegawa Hiro, Ito Masaaki
Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan.
J Anus Rectum Colon. 2018 Jul 30;2(3):110-114. doi: 10.23922/jarc.2017-046. eCollection 2018.
Total mesorectal excision or mesorectal excision with lateral lymph node dissection (LLND) is a standard treatment for locally advanced lower rectal cancer in Japan. Although laparoscopic LLND for rectal cancer is technically complex and challenging, previous studies have demonstrated its feasibility, and the procedure is gradually becoming more common. With this increased use, the incidence of new complications specific to laparoscopic LLND is likely to increase, and a greater awareness of these complications is required. Here we report two cases of internal hernia of the small bowel through an orifice of the vesicohypogastric fascia below the superior vesical artery after laparoscopic LLND. There are six previous reports of internal hernia underneath the pelvic blood vessel after pelvic lymph node dissection for urological or gynecological malignancies, but our cases are the first two that occurred after LLND for rectal cancer. Almost all cases, including our two cases, occurred after laparoscopic surgery and required resection of an incarcerated small bowel. Therefore, the incidence of this complication is likely to increase as the number of cases treated with laparoscopic LLND increases. Our cases show that it is important to perform an emergency operation promptly instead of conservative treatment.
在日本，全直肠系膜切除术或联合侧方淋巴结清扫术（LLND）的直肠系膜切除术是局部进展期低位直肠癌的标准治疗方法。尽管腹腔镜下直肠癌LLND技术复杂且具有挑战性，但既往研究已证实其可行性，且该手术正逐渐变得更为常见。随着其应用的增加，腹腔镜LLND特有的新并发症发生率可能会上升，因此需要对这些并发症有更高的认识。在此，我们报告两例腹腔镜LLND术后经膀胱上动脉下方膀胱下腹膜筋膜孔形成小肠内疝的病例。既往有6篇关于泌尿外科或妇科恶性肿瘤盆腔淋巴结清扫术后盆腔血管下方发生内疝的报道，但我们的病例是首例发生在直肠癌LLND术后的病例。几乎所有病例，包括我们的两例，均发生在腹腔镜手术后，且需要切除嵌顿的小肠。因此，随着腹腔镜LLND治疗病例数的增加，这种并发症的发生率可能会上升。我们的病例表明，及时进行急诊手术而非保守治疗非常重要。
