直腸反転法を用いた腹腔鏡補助下超低位前方切除術を施行した直腸内分泌細胞癌の1例

Laparoscopy-assisted super low anterior resection of the rectum using the prolapsing technique for rectal endocrine cell carcinoma

◆要旨：患者は68歳，男性．2006年6月から便秘，下腹痛があり当科を受診した．直腸診で血液付着を認め，注腸造影検査を施行した．Rbに腫瘤を認め，大腸内視鏡下生検で直腸内分泌細胞癌の診断を得て手術を施行した．腹腔鏡下に中枢側D3郭清を施行し，術中直腸間膜内に明らかなリンパ節転移を認めなかったため，側方郭清を省略し自律神経を温存した．再建は残存直腸の反転法を使用した超低位前方切除を施行した．病理組織検査では内分泌細胞癌，mp，ly1，v1，n（－），stageⅠ，根治度Aであった．術後化学療法を施行し，術後1年経過した現在，無再発生存中である．予後の不良な本疾患に根治性とQOLを重視した術式が可能であった．

　We report a case of a patient who underwent laparoscopy-assisted super low anterior resection of the rectum using the rectal prolapsing technique for the treatment of rectal endocrine cell carcinoma. A 68-year-old man complained of constipation and lower abdominal pain. Barium-enema showed a tumor in Rb. A biopsy specimen on rectal endoscopy was histologically and immunohistologically diagnosed as being rectal endocrine cell carcinoma, therefore, the patient underwent laparoscopy-assisted super low anterior resection of the rectum using the rectal prolapsing technique. Histologically, the tumor was classified as mp, ly1, v1, n（－）, stageⅠ, and Cur A. After surgery, the patient received adjuvant chemotherapy, he has survived for 1 year after the operation without any sign of recurrence. The prognosis of rectal endocrine cell carcinoma is generally very poor. The surgical approach has benefits with respect to the patient's complete cure and quality of life.