―囊胞性腹部疾患―膵囊胞性疾患に対する腹腔鏡下手術

Laparoscopic treatments for cystic diseases of the pancreas

　要旨：膵囊胞性疾患に対する腹腔鏡下手術の適応，手術手技，治療成績を膵囊胞性腫瘍と仮性囊胞に分けて示した．膵囊胞性腫瘍は，漿液性囊胞腫瘍，粘液性囊胞腫瘍，膵管内乳頭粘液性腫瘍が主要な疾患であり，良性や低悪性度の病変に対して腹腔鏡下膵体尾部切除を行っている．12例に施行し，術後合併症は1例に仮性囊胞を発症したが自然軽快し，癌の再発は認めていない．一方，膵仮性囊胞は，6週間持続する6cm以上の病変に対して腹腔鏡下囊胞胃吻合術を行っている．2例に施行し，術後合併症はなく，膵炎に関連した症状が改善した．膵囊胞性疾患の治療に際しては，術前診断を慎重に行い，過不足のない安全な手術を行うことが重要である．

　Our results of laparoscopic treatments for cystic diseases of the pancreas are presented in this paper. Cystic diseases of the pancreas are classified into two major categories ; cystic neoplasm of the pancreas and pancreatic pseudocyst. Laparoscopic distal pancreatectomy（LADP）is indicated for patients with either benign or low grade malignancies of pancreatic cystic neoplasms mainly represented by serous cystic neoplasm, mucinous cystic neoplasm and intraductal papillary mucinous neoplasm. No major complications occurred postoperatively in twelve patients who underwent LADP, except one patient who suffered from pancreatic pseudocyst at the pancreatic stump. The pseudocyst was resolved spontaneously 6 months after the operation. Laparoscopic cystogastrostomy（LACG）is indicated for patients with pancreatic pseudocyst which is larger than 6 cm in diameter and present for more than six weeks. No complications were experienced postoperatively in two patients who underwent LACG, and their symptoms related to chronic pancreatitis were resolved after the operation. In conclusion, careful preoperative diagnosis and safe laparoscopic approach are important to treat pancreatic cystic diseases.