Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Minimally Invasive Therapy Center, Okayama University Hospital, Okayama, Japan.
Asian J Endosc Surg. 2024 Apr;17(2):e13296. doi: 10.1111/ases.13296.
A 52-year-old, Japanese man presented to the hospital with a complaint of anal bleeding, and detailed examination resulted in a diagnosis of locally advanced rectal cancer. The patient underwent total neoadjuvant therapy followed by short-course radiation therapy and consolidation chemotherapy, which provided a partial response. After preoperative contrast-enhanced computed tomography showed a horseshoe kidney, robot-assisted, precise, laparoscopic, low anterior resection with D3 dissection and ileostomy construction was performed. The horseshoe renal isthmus was elevated surrounding the inferior mesenteric artery, and the left ureter and seminal vessels ran in front of the kidney. The hypogastric nerve traveled ventral to the horseshoe kidney. With robotic surgery, it was possible to perform more precise surgery while recognizing vascular and nerve anatomy in a rectal cancer patient with a horseshoe kidney due to good three-dimensional visibility and articulated forceps manipulation.
一位 52 岁的日本男性因肛门出血到医院就诊，详细检查后诊断为局部晚期直肠癌。患者接受了全新辅助治疗，随后进行了短程放疗和巩固化疗，取得了部分缓解。术前增强 CT 显示患者为马蹄肾，遂施行机器人辅助、精准、腹腔镜下低位前切除术加 D3 清扫和回肠造口术。马蹄肾的峡部围绕肠系膜下动脉抬高，左输尿管和精索血管位于肾脏前方。腹下神经位于马蹄肾的腹侧。由于机器人手术具有良好的三维可视性和铰接器械操作，因此对于患有马蹄肾的直肠癌患者，可以在识别血管和神经解剖结构的同时进行更精准的手术。
