総腸骨動脈を含む逆腹膜肉腫に対する対側内腸骨動脈移植術

Contralateral internal iliac artery transposition for retroperitoneal sarcoma involving common iliac artery.

• Cheng-Peng Li
• Bo-Nan Liu
• Jian-Hui Wu
• Chun-Yi Hao

抄録

大血管を侵した後腹膜肉腫（RPS）の完全切除では、血管切除と再建が必要となることが多く、人工移植片の使用は術後の血管感染（VGI）を引き起こすことが多い。人工移植片の使用はしばしば術後の血管移植片感染症（VGI）を引き起こし、通常は再手術を必要とし、時には死に至ることもある。本研究では、2015年～2019年にRPS切除後に総腸骨動脈（CIA）再建のために対側腸骨動脈（IIA）移植を受けたRPS患者のデータをレトロスペクティブに解析した。臨床成績、術中成績、術後成績を記載した。3人の患者において、セグメント切除後のCIAを再構築するために、対照的なIIA転位を行った。すべての患者で臓器切除を併用した。全患者に結腸切除を行い、2人の患者に腎摘出術を行い、1人の患者には経尿道的尿管造設術を伴う左尿管の分割切除を行った。全例で完全切除が達成され、全例でCIAへの顕微鏡的腫瘍浸潤が認められた（中膜前庭：2、中膜：1）。入院中に大きな合併症は発生しなかった。フォローアップ期間中（6.0～29.1ヶ月）に腫瘍の再発で1名が死亡し、他の2名は最新のフォローアップで再発や転移の証拠は認められなかった。下肢機能のレベルは良好であった（MSTS93スコア：28～30）。腸、膀胱、性機能を含む骨盤内臓器機能はいずれの患者でも障害されていなかった。RPS切除後のCIAを再建するために対側IIA移植を行うこの斬新な手技は、単純で信頼性が高く、人工移植に代わる良い選択肢となる可能性がある。

Complete resection for retroperitoneal sarcoma (RPS) involving major vessels frequently requires vascular resection and reconstruction. The use of artificial grafts often leads to postoperative vascular graft infection (VGI), which usually requires reoperation and sometimes leads to death. In the present study, the data of RPS patients who underwent contralateral iliac artery (IIA) transposition for reconstruction of the common iliac artery (CIA) after RPS resection from 2015-2019 were retrospectively analyzed. Clinical, intraoperative, and postoperative outcomes were described. Contralateral IIA transposition was performed to reconstruct the CIA after segmental resection in three patients. All patients underwent concomitant organ resection. Colon resection was performed for all patients, nephrectomy was performed for two patients, and segmental resection of the left ureter with transurethral ureterostomy was performed for one patient. Complete resection was achieved in all patients, and microscopic tumor infiltration to the CIA was observed in all patients (tunica adventitia: 2, tunica media: 1). No major complications occurred during the hospital stay. During the follow-up period (6.0-29.1 months), one patient died from tumor recurrence, and the other two patients did not have any evidence of recurrence or metastatic disease at the latest follow-up. The level of lower limb function was favorable (MSTS93 scores: 28-30). The pelvic organ functions, including bowel, bladder, and sexual functions, were not impaired in any of the patients. This novel technique in which contralateral IIA transposition is performed to reconstruct the CIA after RPS resection is simple and reliable and may be a good alternative to artificial grafts.