腹腔鏡下に側方郭清を施行した側方リンパ節転移を伴う直腸カルチノイドの1例

A rectal carcinoid tumor with lateral lymph node metastasis treated by laparoscopic total mesorectal excision with lateral lymph node dissection : a case report

◆要旨：患者は53歳，女性．腹部膨満感を主訴に当院を受診した．大腸内視鏡検査にて直腸Rbに10mm大の粘膜下腫瘍を認め，肉眼上直腸カルチノイドが疑われた．また腹部造影CTにて左閉鎖領域にリンパ節腫大を認め，左閉鎖リンパ節転移が疑われた．その他遠隔転移はなく，腹腔鏡下超低位前方切除術および左側方郭清を施行した．病理組織学的検査にて，直腸カルチノイド，左閉鎖リンパ節転移と診断された．本邦において側方リンパ節転移を伴った直腸カルチノイドの報告例は少なく，腹腔鏡下に側方郭清を施行したのは自験例が初例であるため，文献的考察を加えて報告する．

Here we report a case of a rectal carcinoid tumor with lateral lymph node metastasis successfully treated by laparoscopic total mesorectal excision with lateral lymph node dissection. A 53-year-old female visited our hospital with a complaint of abdominal distension. Colonoscopy showed a 10mm submucosal tumor at the lower rectum, and abdominal computed tomography showed an enlarged lymph node in the left obturator region. Preoperative diagnosis was a rectal carcinoid tumor with left obturator lymph node metastasis. The patient underwent laparoscopic total mesorectal excision with left lateral lymph node dissection. Histopathological examination confirmed curative resection of a rectal cartinoid tumor with left obturator lymph node metastasis. There have been only five previous reports of lateral lymph node metastasis from rectal carcinoid tumors in Japanese literatures, and this is the first case that underwent laparoscopic lateral lymph node dissection.