Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Musashikoyama IchoNaishikyo Clinic, Tokyo, Japan.
Asian J Endosc Surg. 2024 Oct;17(4):e13357. doi: 10.1111/ases.13357.
Managing colon cancer with intestinal nonrotation, a type of congenital intestinal malrotation, is challenging due to the presence of anatomical abnormalities and severe adhesions. When patients have nonrotation, it is markedly more difficult to determine which vessels correspond to the colic vessels and ileal vessels until all vascular branching patterns become evident. The optimal approach for right-sided colon cancer with intestinal nonrotation has yet to be established. In the present case of ascending colon cancer with intestinal nonrotation, we performed laparoscopic right hemicolectomy with D3 dissection using a modified cranial approach. This approach involves tracing, without resecting, branches from the superior mesenteric vein and superior mesenteric artery in a cranial-to-caudal manner until the ileocolic artery and ileocolic vein, which course toward the cecum, are identified, followed by the dissection of the colic vessels and lymph nodes in a caudal-to-cranial fashion.
管理伴有肠旋转不良的结肠癌具有挑战性，因为存在解剖异常和严重粘连。当患者存在肠旋转不良时，直到所有血管分支模式变得明显，才更难确定哪些血管对应结肠血管和回肠血管。对于伴有肠旋转不良的右侧结肠癌，尚未建立最佳的治疗方法。在本病例中，我们对升结肠癌合并肠旋转不良患者采用改良头侧入路的腹腔镜右半结肠切除术行 D3 解剖。该方法包括沿头侧至尾侧追踪肠系膜上静脉和肠系膜上动脉的分支，而不进行切除，直到识别出朝向盲肠的回结肠动脉和回结肠静脉，然后沿尾侧至头侧方向对结肠血管和淋巴结进行解剖。
