腹腔鏡下十二指腸部分切除術を施行した球部十二指腸癌の1例

Laparoscopic resection of duodenal bulb carcinoma : a case report

◆要旨：十二指腸癌に対する腹腔鏡下十二指腸部分切除術の1例を報告する．患者は79歳，男性．近医で施行された上部消化管内視鏡検査で十二指腸癌と診断された．内視鏡検査所見では径15mm大のIs型腫瘍で生検にてadenocarcinomaと診断された．超音波内視鏡検査で第3層の一部が不明瞭であった．腹部CT検査では原発巣は同定困難で転移所見はなく，転移のない深達度smの十二指腸癌と診断し腹腔鏡下十二指腸部分切除術を施行した．腫瘍は球部の下壁から後壁に位置し腹腔鏡下に全層を部分切除した．手術時間は202分，出血量はカウント外少量であった．術後合併症はなく第7病日に退院した．病理検査所見はadenocarcinoma（pap-tub1），15×12mm，m，ly0，v0であった．十二指腸癌に対する術式は確立されていないが，症例によっては腹腔鏡下手術は有用な術式と考えられる．

　We report a patient with primary duodenal carcinoma who underwent laparoscopic tumor resection. A 79 years old man was diagnosed as having a duodenal cancer. Upper gastrointestinal endoscopic examination revealed a type 0-Is tumor, 15 mm in size, in the duodenal bulb. Biopsy showed the tumor to be adenocarcinoma. Endoscopic ultrasonography reavealed unclear 3 rd layer. In Abdominal CT, the primary tumor was not detected and no metastasis was found. Preoparative diagnosis was submucosal invasion of duodenal adenocarcinoma without metastasis and laparoscopic resection was performed. The tumor was located from caudal to posterior wall of the duodenal bulb. The patient underwent laparoscopic resection with reconstruction of the duodenectomy defect using intracorporeal suturing techniques. Operative time was 202 minutes and blood loss was few. The patient had no postoperative complications and was discharged on 7 postoperative day. Pathological diagnosis was adenocarcinoma（pap-tub 1, 15×12 mm, m, ly0, v0）. There is no consensus of the strategy for duodenal cancer. Laparoscopic partial resection of the duodenum seems to be an option for treatment for duodenal carcinoma of early stages.