重複下大静脈を伴う症例に対する腹腔鏡下傍大動脈リンパ節摘出術

抄録

Objective: Double inferior vena cava is a congenital venous anomaly with an incidence of 1-3%. Several patients with anomalies of the great vessels present with complications such as minor anomalies of blood vessels. A thorough understanding of the positional relationships and anatomical construction is essential to perform safe and effective surgery. At our hospital, as a matter of policy, preoperative three-dimensional computed tomography (3D-CT) is performed in all patients undergoing laparoscopic para-aortic lymphadenectomy (PAN) to confirm the presence of anomalies of the great vessels. We report PAN performed in 2 patients with a double inferior vena cava.

  Both patients presented with early ovarian cancer, and staging surgery including PAN was performed. The double inferior vena cava was identified on preoperative 3D-CT. Transperitoneal PAN was performed in both patients. No other concomitant anomaly was observed. Although a careful operation was required with regard to several points, no massive bleeding necessitating blood transfusion or complications occurred, and surgery could be safely performed.

Conclusion: A transperitoneal approach provides better intraoperative orientation than a retroperitoneal approach, because with this approach, the left inferior vena cava is unlikely to interfere with the operation. Therefore, preoperative 3D-CT may be useful to select the optimal approach for PAN.