Narushima Kazuo, Tonooka Toru, Soda Hiroaki, Amagai Hiroyuki, Chiba Satoshi, Suito Hiroshi, Isozaki Tetsuro, Kuwayama Naoki, Shuto Kiyohiko, Mori Mikito, Kano Masayuki, Nabeya Yoshihiro
Dept. of Esophageal-Gastrointestinal Surgery Chiba Cancer Center.
Gan To Kagaku Ryoho. 2025 Mar;52(3):249-251.
Preoperative understanding of the vascular morphology is important for preservation of the distal sigmoid colon and intraluminal processing of the mesentery in laparoscopic proximal sigmoid colon cancer surgery. We report a case of laparoscopic proximal sigmoid colon cancer surgery using sophisticated surgical-assisted CT colonography (CTC). The surgical-assisted CTC was created by combining a CTC created using SYNAPSE VINCENT and a vascular 3D-CT.
The patient was a woman in 80s with proximal sigmoid colon cancer, cT1bN0M0, cStage Ⅰ. The patient had a history of ascending colon cancer surgery. Contrast-enhanced CTC was performed preoperatively, and 3D-CT images(CTC, arterial 3D-CT, and venous 3D-CT)were created by Workstation(SYNAPSE VINCENT®, FUJIFILM).
Using surgical-assisted CTC, D3 lymph node dissection, in which only the dominant artery, the first and second sigmoid colon artery, and its companion veins were processed, and enterotomy and mesenterotomy line at 10 cm on the oral and anal sides were simulated. Intraoperatively, surgery was performed as planned using surgical-assisted CTC as navigation images. The operative time was 197 minutes, and the blood loss was 30 g. The patient was discharged from the hospital on the 8th day without any postoperative complications. The pathological diagnosis was pT1bN0M0, pStage Ⅰ. There was no recurrence about 9 months after the surgery.
The sophisticated surgical-assisted CTC appeared to be useful in laparoscopic proximal sigmoid colon cancer surgery.
术前了解血管形态对于腹腔镜乙状结肠上段癌手术中保留乙状结肠远端及肠腔内系膜处理至关重要。我们报告一例使用精密手术辅助CT结肠成像（CTC）进行腹腔镜乙状结肠上段癌手术的病例。该手术辅助CTC是通过将使用SYNAPSE VINCENT创建的CTC与血管三维CT相结合而创建的。
患者为一名80多岁的女性，患有乙状结肠上段癌，cT1bN0M0，c期Ⅰ。患者有升结肠癌手术史。术前进行了对比增强CTC检查，并通过工作站（SYNAPSE VINCENT®，富士胶片）创建了三维CT图像（CTC、动脉三维CT和静脉三维CT）。
使用手术辅助CTC，模拟了D3淋巴结清扫术，其中仅处理了主要动脉、第一和第二乙状结肠动脉及其伴行静脉，并在口侧和肛侧10 cm处模拟了肠切开术和肠系膜切开线。术中，以手术辅助CTC作为导航图像按计划进行手术。手术时间为197分钟，失血量为30克。患者于第8天出院，无任何术后并发症。病理诊断为pT1bN0M0，p期Ⅰ。术后约9个月无复发。
精密手术辅助CTC在腹腔镜乙状结肠上段癌手术中似乎是有用的。
