虫垂粘液囊胞腺癌に対する腹腔鏡下手術の経験

Mucinous cystadenocarcinoma of the appendix resected by laparoscopy-assisted colectomy

◆要旨：虫垂粘液囊腫の発生頻度は虫垂切除患者の0.08～0.4％と比較的稀であり，腹膜播種によって腹膜偽粘液腫に至る可能性がある．今回筆者らは，腹腔鏡下回盲部切除および領域リンパ節郭清にて根治切除し得た虫垂粘液囊胞腺癌を経験した．患者は58歳の女性．虫垂囊胞性病変に対する精査にて，虫垂粘液囊胞腺腫（腺癌の疑い）で腹腔鏡下回盲部切除，2群リンパ節郭清を実施した．手術操作では内側アプローチによるno touch techniqueを遂行した．病理組織診断では虫垂粘液囊胞腺癌，pSS，pN0であった．本疾患に対する手術操作は病巣に触れることなく愛護的に行わなければならず，内視鏡下手術はこれらの点を十分に満たすことができると考えられた．

　Mucinous cystadenocarcinoma of appendix vermiformis is a rare subtype of colon epithelial neoplasm and there is a risk of pseudomyxoma peritonei. We resected the neoplasm by laparoscopy-assisted colectomy. A 58year-old female, suspected to have a cyst of appendix vermiformis, was admitted to our hospital. After we carried out ultrasonography, computed tomography, magnetic resonance imaging, colon fiber and barium enema, the existence of mucinous cystoma or mucinous cystadenocarcinoma of appendix vermiformis was demonstrated. Laparoscopy-assisted ileocecal resection with regional lymph nodes dissection（D2）was performed after we received informed consent. During the surgery, we have accomplished“notouch technique”by medial approach. The final pathological diagnosis revealed the tumor to be mucinous cystadenocarcinoma with subserosa-invasion and no lymph node matastasis. It is necessary to perform the surgery against this neoplasm by tremendously protectable technique, therefore, we concluded that laparoscopic surgery is one of the acceptable technique for mucinous cystadenocarcinoma without pseudomyxoma peritonei. Herein we report a case of mucinous cystadenocarcinoma of appendix vermiformis with some literature reviews.