Miyake Eiki, Taniguchi Fumitaka, Nosaka Mikone, Mohri Kengo, Sato Maho, Hatono Minami, Kajioka Hiroki, Ogawa Toshihiro, Watanabe Megumi, Arata Takashi, Katsuda Koh, Tanakaya Kohji, Aoki Hideki
Dept. of Surgery, National Hospital Organization Iwakuni Clinical Center.
Gan To Kagaku Ryoho. 2024 Dec;51(13):1425-1427.
The patient was a 73-year-old female with left lower abdominal pain. Colonoscopy revealed a tumor in the transverse colon, which was biopsied and diagnosed as a well-differentiated adenocarcinoma. Computed tomography revealed incomplete formation of the ligament of Treitz, with the small bowel located in the right abdomen and the ascending colon along the midline. The superior mesenteric vein(SMV)was positioned on the left side of the superior mesenteric artery(SMA). The tumor was located in the central part of the transverse colon. The patient was diagnosed with transverse colon cancer with intestinal malrotation before surgery. Laparoscopic partial colectomy(of the transverse colon)was performed. The lymph nodes were dissected from the right margin of the SMV. The middle and right colic arteries were severed, and D3 lymph node dissection was performed. The colon was found to have shifted to the left side, with extensive adhesions between the omentum and mesocolon. The postoperative pathological diagnosis was tub1, pT3, pN0, pM0, and pStage Ⅱ a. Intestinal malrotation was diagnosed preoperatively, and unusual vascular positioning was identified. Consequently, we were able to perform safe and adequate lymph node dissection during laparoscopic surgery.
该患者为一名73岁女性，有左下腹疼痛。结肠镜检查发现横结肠有一个肿瘤，经活检诊断为高分化腺癌。计算机断层扫描显示Treitz韧带形成不全，小肠位于右腹部，升结肠沿中线走行。肠系膜上静脉（SMV）位于肠系膜上动脉（SMA）左侧。肿瘤位于横结肠中部。患者术前被诊断为横结肠癌伴肠旋转不良。行腹腔镜部分结肠切除术（横结肠）。从SMV右缘清扫淋巴结。切断中结肠动脉和右结肠动脉，行D3淋巴结清扫。发现结肠向左移位，大网膜和结肠系膜之间有广泛粘连。术后病理诊断为tub1，pT3，pN0，pM0，pⅡa期。术前诊断为肠旋转不良，并发现异常血管定位。因此，我们能够在腹腔镜手术期间进行安全且充分的淋巴结清扫。
