S状結腸癌・十二指腸乳頭部癌の重複癌に対して腹腔鏡下同時手術を施行した1例

Combined laparoscopic surgery for synchronous cancers of the ampulla of Vater and sigmoid colon

◆要旨：患者は62歳の女性で，血便と発熱を主訴に来院し，精査にてS状結腸癌および十二指腸乳頭部癌と診断された．まず5ポートで腹腔鏡下前方切除術を施行し，左右季肋下に5mmポートを追加して腹腔鏡下幽門輪温存膵頭十二指腸切除術を施行した．標本は臍部創を5cmに拡大して摘出した．手術時間は683分で，出血量は105gであった．術後経過は良好で術後14日目に退院した．定型化した手技を組み合わせることでS状結腸癌と十二指腸乳頭部癌の重複癌に対して腹腔鏡下同時手術は安全に施行可能であった．膵切除を伴う腹腔鏡下同時切除について若干の考察を加えて報告する．

　［Introduction］ We successfully performed laparoscopic pylorus-preserving pancreaticoduodenectomy and anterior resection of the rectum at the same time for a patient with synchronous double cancers of the ampulla of Vater and sigmoid colon.［Case］ The patient was a 62-year-old female. She was admitted with bloody stool and fever elevation. She was diagnosed with synchronous double cancers of the ampulla of Vater and sigmoid colon upon examination. She underwent combined laparoscopic surgery. In the lithotomy position, anterior resection of the rectum was performed first by 5-port technique. Afterward, two 5-mm trocars were added just beneath the right and left costal arch, and pylorus-preserving pancreaticoduodenectomy was performed. Both specimens were removed via an umbilical incision enlarged to 5 cm. The operative time was 683 minutes and the blood loss was 105 g. Her postoperative course was good, and she was discharged on POD 14.［Discussion］ Such combined laparoscopic surgery could be achieved by using standardized procedures. However, further consideration about safety is required.