Shigoka Masatoshi, Hidaka Eiji, Tomita Koichi, Nakagawa Masashi, Yokozuka Kei, Miyoshi Kenta, Sano Toru, Tabuchi Satoru, Chiba Naokazu, Katayanagi Sou, Nagakawa Yuichi, Katsumata Kenji, Tsuchida Akihiko, Kawachi Shigeyuki
Dept. of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center.
Gan To Kagaku Ryoho. 2020 Dec;47(13):2308-2310.
A 77-year-old man was admitted to our hospital because of a positive occult blood test result and diagnosed as having left transverse colon cancer(cT2N0M0)on detailed examination. The patient underwent a sigmoidectomy for colon cancer 24 years previously. Three-dimensional(3D)-CT angiography was performed before the present operation. The left branch of the middle colic artery, which was independently branched, and the marginal artery of the colon were found to be supplying blood from the left side of the transverse colon to the anastomosis of the sigmoid colon. In addition, the root of the left branch of the middle colic artery arose from the caudal side of the first jejunal vein. Therefore, a left hemicolectomy was performed. In accordance with the preoperative simulation, we safely resected the left branch of the middle colic artery at the root. Intraoperative blood flow evaluation using indocyanine green(ICG)fluorography clearly displayed the demarcation of the oral blood flow and the point of anastomosis. No notable complications occurred after the surgery. The results of the pathological analyses indicated a pT1bN0M0 tumor stage. Therefore, we conclude that 3D-CT angiography and ICG fluorography are useful for performing safer operations for left transverse colon cancers.
一名77岁男性因潜血试验结果呈阳性入住我院，经详细检查被诊断为左半横结肠癌（cT2N0M0）。该患者24年前曾因结肠癌接受过乙状结肠切除术。本次手术前进行了三维（3D）CT血管造影。发现独立分支的中结肠动脉左支和结肠边缘动脉从横结肠左侧向乙状结肠吻合口供血。此外，中结肠动脉左支的根部起自第一空肠静脉的尾侧。因此，实施了左半结肠切除术。根据术前模拟，我们在根部安全地切除了中结肠动脉左支。使用吲哚菁绿（ICG）荧光造影进行术中血流评估清楚地显示了近心端血流的分界和吻合点。术后未发生明显并发症。病理分析结果显示肿瘤分期为pT1bN0M0。因此，我们得出结论，3D-CT血管造影和ICG荧光造影有助于对左半横结肠癌进行更安全的手术。
