用手補助腹腔鏡下に摘出した成人仙尾部奇形腫の1例

A case of adult sacrococcygeal teratoma resected by a hand-assisted laparoscopic approach

◆要旨：患者は23歳，女性．骨盤腔内の腫瘍を指摘されて当院に紹介され入院となった．MRIにて仙骨前面に約10cmの囊胞性腫瘍を認め，仙尾部奇形腫の診断のもと用手補助腹腔鏡下に腫瘤を摘出した．摘出標本は径10×8cmの多房性囊胞腫瘍，内容物は粥状で，囊胞性成熟奇形腫と診断された．本疾患は仙尾骨から発生する先天性腫瘍で，成人例の報告は少ない．治療は腫瘍の完全切除で，直視下に腫瘍が観察可能な経仙骨的アプローチが一般的である．自験例は若年女性，骨盤腔に限局した腫瘍であることより，用手補助腹腔鏡下の経腹的アプローチを選択した．本法は良好な視野で手術が可能であり，有用な術式と考えられた．

　A 23-year-old woman was referred to us with a large incidentally discovered intrapelvic mass. A MRI showed a 10-cm presacral cystic mass. Under the preoperative diagnosis of the sacrococcygeal teratoma, surgical resection was carried out using a hand-assisted laparoscopic approach. The histological findings of the tumor with atheroma-like content, 10×8×6 cm in size, showed mature teratoma. The sacrococcygeal teratoma is a congenital tumor originating from the sacrum and is comparatively rare in adults. The primary treatment is complete surgical excision and the sacrococcygeal approach, enabling us to see the tumor well, is often used. A laparoscopic approach was used in our case because of the large tumor was limited in the pelvis of the young woman. This approach can provide good view and easy access to the intrapelvic region and is considered as a minimally invasive and useful treatment.