ダブルバルーン小腸内視鏡により同定し，腹腔鏡補助下に切除した小腸GISTの1例

Gastrointestinal stromal tumor detected by double-balloon endoscopy and treated by laparoscopy-assisted surgery : a case report

◆要旨：患者は44歳の男性であり，下血，貧血を主訴に他院を受診した．上・下部消化管内視鏡検査，出血シンチグラフィにて出血部位が同定できず，当院に紹介された．ダブルバルーンシステムによる小腸全域の精査にて，Treitz靭帯より約20cm肛門側の空腸に小腸腫瘍を認めた．検査時に点墨を施すことにより腫瘍が術中に同定可能であり，腹腔鏡補助下に腫瘍を含む小腸部分切除を施行し得た．病理組織検査の結果はc-kit（＋），CD34（－），desmin（－），vimentin（＋），α-SMA（部分的に＋），S-100蛋白（－）であり，小腸GISTと診断した．

　A 44-year-old man, complaining of melena and anemia, was referred to our hospital because the bleeding site could not be detected by gastrointestinal endoscopy and colonoscopy. Double-balloon endoscopy performed at our hospital revealed a submucosal tumor with a small ulcer in the upper jejunum. Since the tumor was suspected to be a gastrointestinal stromal tumor（GIST）, we performed a laparoscopy-assisted partial resection of the jejunum. Immunohistochemically, the tumor cells were positive for c-kit and vimentin but negative for CD34, desmin, S-100 protein, and HHF-0. The tumor was diagnosed as GIST, low risk type. No signs of recurrence have been observed for at least 6 months after surgery.