多発直腸カルチノイドに対して腹腔鏡下内肛門括約筋切除術を施行した1例

Multiple rectal carcinoid tumors treated by laparoscopic intersphincteric resection : a case report

◆要旨：患者は63歳，男性．下部消化管内視鏡検査にて下部直腸に多発する大きさ5mm以下の粘膜下腫瘍を認め，生検でカルチノイドと診断された．1年の経過観察の後，2病変に対して内視鏡的粘膜切除術を施行し，1病変にて脈管侵襲陽性であった．リンパ節転移の可能性も否定できないため，腹腔鏡下内肛門括約筋切除術を施行した．病理組織学的に多発カルチノイドと4個のリンパ節転移を認めた．多発直腸カルチノイドは比較的稀な疾患であるが，多発例ではリンパ節転移の可能性が単発例より高く，治療においては注意が必要である．今回，筆者らはリンパ節転移を伴った多発直腸カルチノイドの1例を経験したので，若干の文献的考察を加えて報告する．

　The patient was a 63-year-old man who was diagnosed as multiple rectal carcinoid tumors that were smaller than 5mm by endoscopic examination. After one year follow-up, endoscopic mucosal resection（EMR） was performed for two lesions, and histopathological findings showed that one of them had venous invasion. Laparoscopic total mesorectal excision with intersphincteric resection and colo-anal anastomosis was performed. Histopathologically, there were3perirectal and 1 intermediate lymph node metastases. Although multiple rectal carcinoid tumors are rare, analysis of previously reported25cases of multiple rectal carcinoid tumors indicate that the incidence of lymph node metastases is very high. Therefore, surgery with lymph node dissection should be considered for multiple rectal carcinoid tumors.