腹腔鏡下天蓋切除術を施行したCA19-9産生性脾囊胞の1例

Laparoscopic dome resection for a CA 19-9 producing splenic cyst : a case report

◆要旨：患者は27歳の女性．左側腹部痛と食物つかえ感を主訴に近医を受診し，精査加療目的にて当院に紹介となった．腹部CT検査で，脾上極に12×10cm大の単房性囊胞を認めた．術前CA19-9値は766U/mlと高値であったが，画像検査で悪性所見はなく，手術を施行した．手術は3本のポートで行い，S.A.N.D.バルーンカテーテルを用いて囊胞内容を吸引後，囊胞壁を脾臓実質近傍で切離した．囊胞内容液のCA19-9値は328,000U/mlと高値を示し，囊胞壁は石灰化を伴う線維性結合織から成り，仮性囊胞と診断された．脾囊胞に対する腹腔鏡下天蓋切除術は低侵襲であり，脾機能温存の点からも有用な術式と考えられた．

　A 27-year-old woman was admitted to our hospital with the complaint of left abdominal pain and dysphagia. Abdominal CT revealed a 12×10 cm monolocular cystic lesion in the upper pole of the spleen, and serum CA 19-9 value showed high level of 766 U/ml. No apparent findings of malignancy were identified by imaging, so the operation was performed with the diagnosis of a splenic cyst. At first, 3 ports were inserted into her abdomen and S.A.N.D. balloon catheter was used for suction of the intracystic fluid. The cystic fluid was brown, and CA 19-9 in the cystic fluid was as high as 328,000 U/ml. The proximal region transitional to the parencymal spleen was resected. A cyst wall consisted of fibrous connective tissue with calcification. Histopathology revealed it to be a pseudocyst. Laparoscopic dome resection for splenic cyst is a safe and useful procedure for the preservation of splenic function.