腹腔鏡下手術を施行した膵内分泌腫瘍の2例

Laparoscopic surgery for two cases of endocrine tumor of the pancreas

◆要旨：膵内分泌腫瘍は稀な腫瘍で，その外科治療は従来，開腹で行われることが多かったが，内視鏡下手術のよい適応であると思われる．筆者らは2例の膵内分泌腫瘍に対して腹腔鏡下手術を施行した．［症例1］は昏睡で発症し，膵尾部に1.1cm大のinsulinomaが見つかった32歳，女性で，脾動静脈・脾臓温存の膵尾部切除を施行した．［症例2］は人間ドックで膵頭部に1.3cm大の非機能性膵内分泌腫瘍を指摘された59歳，男性で，腫瘍核出術を施行した．手術はともに完全内視鏡下に施行し，手術時間は132分と84分，出血量は3gと7g，術後在院日数は5日と6日で術後合併症なく退院した．病理組織学的検査では，それぞれ良性のinsulinomaと非機能性内分泌腫瘍と診断された．

　Although endocrine tumors of the pancreas are traditionally managed by laparotomy, these rare neoplasms may be amenable to laparoscopic surgical resection. We present our experience with laparoscopic distal pancreatectomy for a pancreatic insulinoma and laparoscopic enucleation for a nonfunctioning pancreatic endocrine tumor. A 32 year old female patient presented with clinical and biochemical features of an insulinoma and was found on cross sectional imaging to have a 1.1 cm solitary tumor in the tail of the pancreas. She underwent laparoscopic distal pancreatectomy with preservation of splenic vessels and spleen. A 59-year-old male patient was pointed out the existence of a pancreatic tumor on ultra-sonic examination and was revealed on dynamic CTscan and biochemical examination to have a 1.3 cm solitary nonfunctioning endocrine tumor in the head of the pancreas. He underwent laparoscopic enucleation. Both procedures were completed laparoscopically. The operative time was 132 and 84 minutes and the blood loss was 3 and 7 g, respectively. There were no postoperative complications. The postoperative hospital stay was 5 and 6 days, respectively. Histology revealed a benign insulinoma and a benign nonfunctioning endocrine tumor.