用手補助腹腔鏡下脾摘出術を施行した脾リンパ管腫の1例

A case report of hand-assisted laparoscopic splenectomy for a lymphangioma of the spleen

症例は53歳，女性．2001年2月に検診で肝障害を指摘され，近医で腹部超音波検査を施行したところ2cm大の脾囊胞を指摘された．その後，徐々に増大して5cm大となったため2005年5月に当院を紹介された．腹部CTでは5.2×4.4cm大の多房性囊胞を認めたが，腫瘍濃染像や壁在結節などは認めなかった．悪性疾患を否定できないため用手補助腹腔鏡下脾摘出術を施行した．術後病理組織検査結果は脾リンパ管腫であった．標本を細切せずに体外へ取り出すためには小開腹が必要であり，小開腹創を手術操作のために用いる本術式は極めて合理的な方法であると考えられた．

　A 53-year-old woman was pointed out liver dysfunction at a medical checkup in February 2001, and found to have a splenic cyst about 2 cm in diameter by abdominal ultrasonography at a near by physician. She was referred to our hospital in May 2006 because the cyst increased in size to 5 cm in diameter. Abdominal CT revealed a 5.2×4.4 cm multilocular cystic lesion, but no enhancement nor mural nodule were seen. Because malignant disease could not be denied, hand-assisted laparoscopic splenectomy was performed. The pathological result was a lymphangioma of the spleen. Mini-laparotomy was necessary to remove the specimen without morcellation from the abdominal cavity. Therefore, it was thought that this technique which required mini-laparotomy for the operation was quite a rational method.