腸重積をきたした空腸粘膜癌に対して単孔式腹腔鏡補助下手術を施行した1例

A case of intussusception of an intramucosal jejunum cancer treated by single incision laparoscopic surgery

◆要旨：患者は71歳，女性．腹痛，嘔吐を主訴に受診した．腹部CT検査で腸重積，腸閉塞と診断，イレウス管留置，腸管減圧後にダブルバルーン小腸内視鏡検査を行った．トライツ靭帯から40cmの空腸に隆起性腫瘍を認め，マーキングを行った．生検結果は高分化腺癌であった．空腸癌の診断で単孔式腹腔鏡補助下空腸部分切除術を行った．切除標本は径70×30mm大のIp型腫瘍であり，管状絨毛腺腫を伴う高~中分化腺癌だった．癌は粘膜内に留まり，リンパ節転移を認めなかった．術後6か月で転移，再発なく経過している．ダブルバルーン小腸内視鏡検査は病変部位の同定と病理診断に有用であり，単孔式腹腔鏡補助下手術は整容性に優れていると思われた．

　A 71-year-old woman presented with abdominal pain and vomiting. Computed tomography deliueated an obstruction caused by jejunal intussusception. Following nasogastric decompression, double-balloon endoscopy revealed a tumor in the upper jejunal wall 40 cm from the ligament of Treitz. The intussusception was released and biopsies were taken without complication. The histological diagnosis was a well differentiated adenocarcinoma, which was then treated with single incision laparoscopic partial jejunectomy. The resected specimen was a type Ip tumor, measuring 70×30 mm. Histopathological examination demonstrated a well differentiated adenocarcinoma with a tubulovillous adenoma component. Depth of invasion was confined to the lamina propria mucosa and all lymph nodes were negative for metastasis. The patient was doing well without recurrence six months postoperatively. Preoperative double balloon endoscopy is useful for the localization and diagnosis of intestinal pathology and provides and facilitates the planning of more complicated procedures such as bowel resection. The single incision laparoscopic approach afforded greater visibility over endoscopy with excellent cosmesis.