腹腔鏡下に完全切除し得た成人後腹膜リンパ管腫の1例

A case of total laparoscopic excision of retroperitoneal cystic lymphangioma

◆要旨：患者は28歳，女性．健診を機会に，右下腹部に13×11×5cm大の囊胞性後腹膜リンパ管腫と診断された．重苦感を伴うため，十分なインフォームド・コンセントのうえ，腹腔鏡下の摘出を施行した．恥骨上をカメラポート，左右の鼠径上と臍部の3か所をワーキングポートとし，気腹法にて施行した．右側結腸間膜背側に囊胞が透見され，結腸間膜尾側から囊胞に達し，頭側方向へ剝離を進めた．おおむね2/3を剝離後，S.A.N.D.バルーンカテーテルを囊胞に穿刺し，牽引に利用しながら残りを剝離した．剝離操作は全周にわたり容易であった．手術時間は99分で第5病日目に退院した．本症に対する腹腔鏡下切除はわが国では6例目であるが，容易であり，整容的にも非常に有用であった．

　A 28-year-old woman was discovered to have a tumor in the lower right retroperitoneal space by a medical check. CT and MRI showed a monolocular cyst 13×11×5 cm in diameter without solid component. We diagnosed the tumor as retroperitoneal cystic lymphangioma. After informed consent, laparoscopic excision was performed. A 12 mm port was placed in the supra pubic position for CO₂ insufflation and laparoscope was introduced into the abdominal cavity through this port. A 5 mm working port was placed in the bilateral supra inguinal position and umbilical position. The cyst was seen through the right mesocolon. The mesocolon was dissected from retroperitoneum and then the cyst wall was revealed. After 2/3 of the cyst wall was dissected from mesocolon and retroperitoneum, it became difficult to dissect. Therefore the S.A.N.D ballon catheter^Ⓡ was stabbed into the cyst and utilized to aspirate the fluid content and for retraction. It became easy to dissect the entire cyst wall. Operating time was 99 minutes. Patient was discharged on 5 post operative day. Laparoscopic excision for this disease was reported in 6 cases in Japan. This procedure was easy and cosmetically effective.