Fujiwara Sho, Kaino Kenji
Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, JPN.
Cureus. 2022 Aug 12;14(8):e27942. doi: 10.7759/cureus.27942. eCollection 2022 Aug.
Although rare, persistent descending mesocolon (PDM) is an anatomical anomaly that carries potential risks for laparoscopic colorectal surgery. Impaired blood circulation of the reconstructed colon is especially risky during surgery. We report a case of sigmoid cancer with PDM, in which the patient underwent laparoscopic sigmoidectomy. A 52-year-old man diagnosed with sigmoid cancer was referred to our hospital. PDM was identified with preoperative enhanced-contrast computed tomography, which revealed the sigmoid colon located in the right lower quadrant and a bear-claw inferior mesenteric artery (IMA). Preoperative examination showed cT1N0M0 stage I (Union for International Cancer Control {UICC} eighth). We were not able to identify the branches of IMA after the medial-to-lateral approach. We divided the mesentery and marginal artery and the main branches from IMA extracorporeally prior to lymphadenectomy. Each oral and anal side was dissected without touching the tumor. Then, we marked the line for lymphadenectomy using the dissected line of mesentery as an intracorporeal landmark. Pathological findings showed pT1N0M0 stage I (UICC eighth edition). The patient was discharged without complications. Using this approach and the preoperative recognition of PDM, we performed laparoscopic sigmoidectomy with lymphadenectomy for early-stage PDM case successfully and safely. Our mesocolon dissection-first approach could be a feasible and safer approach for early-stage sigmoid cancer.
尽管罕见，但持续性降结肠（PDM）是一种解剖学异常，给腹腔镜结直肠癌手术带来潜在风险。重建结肠的血液循环受损在手术期间尤其危险。我们报告一例患有PDM的乙状结肠癌病例，该患者接受了腹腔镜乙状结肠切除术。一名被诊断为乙状结肠癌的52岁男性被转诊至我院。通过术前增强对比计算机断层扫描识别出PDM，其显示乙状结肠位于右下腹且肠系膜下动脉（IMA）呈熊爪状。术前检查显示为cT1N0M0 Ⅰ期（国际癌症控制联盟{UICC}第八版）。在从内侧到外侧入路后，我们无法识别IMA的分支。在淋巴结清扫术前，我们在体外将肠系膜、边缘动脉和IMA的主要分支进行了分离。分别在不触碰肿瘤的情况下对远近端进行了游离。然后，我们以肠系膜的游离线作为体内标志来标记淋巴结清扫线。病理结果显示为pT1N0M0 Ⅰ期（UICC第八版）。患者无并发症出院。通过这种方法以及术前对PDM的识别，我们成功且安全地对早期PDM病例实施了腹腔镜乙状结肠切除术并进行了淋巴结清扫。我们的结肠系膜优先游离法对于早期乙状结肠癌可能是一种可行且更安全的方法。
