腹腔鏡下虫垂切除後に虫垂カルチノイドと判明し，再度腹腔鏡補助下右結腸切除術を施行した1例

Successful laparoscopic-assisted right colectomy in patient with appendiceal carcinoid following laparoscopic appendectomy

◆要旨：患者は29歳，女性．心窩部痛を主訴に他院を受診し，急性虫垂炎の診断で手術目的に当科を紹介され，腹腔鏡下虫垂切除術を施行した．術後の病理組織検査にて虫垂カルチノイド，深達度漿膜下層，断端陽性と診断され，追加切除のため腹腔鏡補助下に2群郭清を伴う右結腸切除を行った．病理検索にて腫瘍の遺残はなくリンパ節転移も認めなかった．術後10か月現在，再発はなく，外来にて経過観察中である．2回の腹腔鏡下手術を行った虫垂カルチノイドの報告例は少なく，若干の文献的考察を加え，報告する．

　A 29-year-old female patient with epigastralgia was diagnosed with acute appendicitis and underwent laparoscopic appendectomy. Macroscopically, a diffusely inflamed appendix was found with no sign of perforation. Histopathological examination revealed a argentaffin carcinoid with characteristics of invasion to the subserous layer, and suspected tumor involvement at the margin, indicating the need for additional resection. Subsequent laparoscopic-assisted right colectomy was performed, and fortunately neither residual tumor nor metastatic lymph nodes could be confirmed pathologically in the specimen. The patient is well more than 10 months after the second surgery without any signs of recurrence. We experienced laparoscopic two-stage surgery for carcinoid of the appendix. Japanese literature review revealed only 3 patients including our patient.