Hara Kazushi, Yamamoto Manabu, Sawata Shohei, Kono Yusuke, Kihara Kyoichi, Matsunaga Tomoyuki, Tokuyasu Naruo, Sakamoto Teruhisa, Fujiwara Yoshiyuki
Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan.
Yonago Acta Med. 2022 Jul 23;65(3):262-265. doi: 10.33160/yam.2022.08.003. eCollection 2022 Aug.
The retroperitoneal intestinal vein-general circulation anastomotic pathway is referred to as a Retzius shunt; however, it is not a well-recognized condition. Here, we describe two patients with a Retzius shunt who underwent robot-assisted surgery for rectal cancer. The first case was an 81-year-old woman who had tested positive for fecal occult blood. A type 0-Is tumor was found in the middle rectum, and we used robot-assisted surgery for resection. Intraoperative findings included a dilated vein between the inferior mesenteric artery (IMA) and inferior mesenteric vein (IMV); further, computed tomography (CT) revealed flow into the inferior vena cava (IVC). We clipped the vein without major bleeding and the tumor-specific mesorectal excision was completed. Thereafter, we reviewed relevant literature and identified the structure to be a Retzius shunt. The second case was 77-year-old man with type 1 advanced cancer in the middle rectum who underwent robot-assisted surgery. In this case, we recognized the Retzius shunt on preoperative CT due to our experience with the first case and surgery was completed without any problems. Preoperative recognition of vascular malformations, such as the Retzius shunt by CT is critical to ensure the safety of robot-assisted surgery.
腹膜后肠静脉-体循环吻合途径被称为雷济厄斯分流；然而，这并非一种广为人知的病症。在此，我们描述了两名患有雷济厄斯分流并接受了机器人辅助直肠癌手术的患者。首例病例是一名81岁女性，粪便潜血检测呈阳性。在直肠中段发现了0-Is型肿瘤，我们采用机器人辅助手术进行切除。术中发现包括肠系膜下动脉（IMA）和肠系膜下静脉（IMV）之间的静脉扩张；此外，计算机断层扫描（CT）显示有血流流入下腔静脉（IVC）。我们夹住该静脉，未发生大出血，并完成了肿瘤特异性直肠系膜切除术。此后，我们查阅了相关文献，确定该结构为雷济厄斯分流。第二例病例是一名77岁男性，直肠中段患有1型进展期癌症，接受了机器人辅助手术。在该病例中，由于我们有首例病例的经验，在术前CT上识别出了雷济厄斯分流，手术顺利完成。术前通过CT识别血管畸形，如雷济厄斯分流，对于确保机器人辅助手术的安全性至关重要。
