腹腔鏡下に摘出した尾腸囊胞の2例

Two cases of tailgut cysts removed using a laparoscopic approach

◆要旨：［症例1］32歳，女性．仙骨前面に多房性囊胞性病変を認め，尾腸囊胞が疑われた．腹腔鏡下に肛門挙筋を一部合併切除し腫瘍を摘出した．［症例2］76歳，女性．下部直腸背側から坐骨直腸窩にかけて多房性囊胞性病変を認め，尾腸囊胞を疑った．腹腔鏡による経腹アプローチとジャックナイフ位での会陰アプローチを併用して腫瘍を摘出した．尾腸囊胞は悪性化することがあり，完全切除が原則である．一方，排便や排尿の機能温存も重要であり，占拠部位や大きさによって，経腹操作だけでなく，会陰操作や経仙骨的操作などを組み合わせ，適切なアプローチを選択すべきである．挙筋上腔を占拠する病変に対する術式として，明るい視野と拡大視効果により精密な操作が可能な腹腔鏡下手術は非常に有用であり，機能温存に寄与すると考えられた．

　Case 1 was a 32-year-old woman with a multiple cystic lesion in the retrorectal space. A tailgut cyst was suspected based on the location of the tumor and the findings of pelvic magnetic resonance imaging. The tumor was removed laparoscopically with part of the levator anus muscle. Case 2 was a 76-year-old woman with a multiple cystic lesion from the dorsal side of the lower rectum to the ischiorectal fossa. A tailgut cyst was suspected. The tumor was removed using a combination of laparoscopic and perineal approaches. Tailgut cysts have to be removed completely because they can become malignant. On the other hand, it is also important to preserve the function of defecation and urination. Appropriate approach should be selected according to the location and size of the tumor. Laparoscopic surgery is a very useful technique for the treatment of tumors occupying the suprapubic space because of its bright visual field and magnification which allows precise manipulation, and for the preservation of function.