腹腔鏡下に切除した十二指腸上行部後壁GISTの1例

Laparoscopic resection of a GIST located in the posterior wall of the ascending part of the duodenum : a case report

◆要旨：十二指腸上行部後壁GIST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73歳の男性．S状結腸癌の術前の腹部CT検査で十二指腸上行部後壁の壁外に突出する20mm大の境界明瞭な腫瘍を認めた．S状結腸癌の術前診断はSM，N0，M0；Stage Iであり，一期的に腹腔鏡下手術を施行した．腹腔鏡補助下S状結腸切除術に引き続き，十二指腸上行部後壁を授動して，自動縫合器を用いて十二指腸上行部の部分切除を行った．術後合併症はなく，術後第9病日に退院となった．十二指腸腫瘍の病理検査結果はc-kit蛋白（＋）の腫瘍細胞の増殖を認め，MIB-1 index＜1％であり，低リスクのGISTと診断された．術後1年経過した現在再発を認めていない．

　We report a case of a GIST located in the posterior wall of the ascending part of the duodenum, which could be resected laparoscopically. A 73-year-old man was admitted in order to remove a sigmoid colon cancer. On abdominal CT, another tumor, which was 20mm in size and well-demarcated, was found in the posterior wall of the ascending part of the duodenum. Preoperative staging of the sigmoid colon cancer was Stage I （T1, N0, M0）. The patient synchronously underwent laparoscopic resection of the sigmoid colon cancer and the duodenal tumor. Laparoscopic sigmoidectomy was followed by laparoscopic duodenal partial resection using a linear stapler. The patient had no postoperative complication and was discharged on the 9 postoperative day. Histopathologically, the duodenal tumor showed positive reaction for c-kit protein, and MIB-1 index was less than 1%. The pathological diagnosis was GIST with low risk. One year after the operation, the patient had no recurrence.