腹腔鏡下局所切除術を施行した下行脚膵臓側の十二指腸GISTの1例

Laparoscopic partial resection for GIST located in the descending part of duodenum : Report of a case

◆要旨：患者は60歳，女性．当科で直腸癌に対する手術後，定期通院中であった．フォローアップのCTで，十二指腸下行脚膵臓側に22mm大の腫瘍を認め，十二指腸gastrointestinal stromal tumor（GIST）が疑われた．MRIでは乳頭からは距離があり，局所切除が可能と判断した．腹腔鏡下に右側結腸を脱転して膵頭十二指腸前面の視野を展開し，腫瘍を慎重に膵臓から剝離していった．マージンをとって十二指腸壁とともに全周性に局所切除し，2層にて縫合閉鎖した．病理検査でGIST（低リスク）と診断された．経過良好で術後6日目に退院となり，術後18か月現在無再発生存中である．

　A 60-year-old woman had undergone laparoscopic anterior resection for rectal cancer six months previously in our department. Follow-up computed tomography showed a 22mm sized tumor on the pancreatic side of the descending duodenum, and a duodenal GIST was suspected. Magnetic resonance imaging showed that there was sufficient distance from the tumor to the duodenal papilla; therefore, local resection was possible. Laparoscopic partial duodenectomy was performed. We mobilized the right hemicolon to secure a good surgical sight of the pancreatic head and duodenum. The tumor was carefully dissected from the pancreatic parenchyma and resected with reliable margins. The hole in the duodenum was closed by suturing two layers. Pathologically, the tumor was diagnosed as a GIST. The patient was discharged on postoperative day 6 without any complications and had no recurrence 18 months postoperatively.