腹腔鏡下に切除した大網原発GISTの1例

A case of gastrointestinal stromal tumor of the greater omentum resected by laparoscopic surgery

◆要旨：患者は57歳，男性．腹部造影CTにて偶然腹腔内に腫瘤を認め紹介となった．腫瘤は直径5cm程度で大網内に存在し胃大網動脈から栄養を受けていた．大網原発GISTを疑ったが確定診断が得られず，total biopsy目的で手術を施行した．手術は腹腔鏡下に施行し，腫瘤を把持することなく腫瘤周囲の大網をvessel sealing systemを用いて切離し腫瘤を摘出した．腫瘤の大きさは65×55×40mmで，病理学的所見にて大網原発GISTの診断となった．術後9日目に合併症なく退院となった．大網原発GISTを疑った場合は，腹腔鏡下に安全に手術を施行できる可能性があるため，腹腔鏡にて腹腔内を観察することが重要であると思われた．

　A 57-year-old man was referred to our hospital for an intraabdominal tumor that was incidentally detected by contrast-enhanced abdominal computed tomography. The tumor, measuring approximately 5 cm in diameter, was located within the greater omentum and was fed by gastroepiploic artery. Primary omental gastrointestinal stromal tumor（GIST） was suspected but not confirmed, and complete resection was performed for diagnosis and treatment. The tumor was laparoscopically enucleated by separating the surrounding greater omentum using a vessel-sealing system without grasping the tumor. The tumor measured 65×55×40mm, and pathological findings led to a diagnosis of primary omental GIST. The patient was discharged without any complications on postoperative day 9. Laparoscopic surgery is safe and feasible in selected patients with suspected primary omental GIST; therefore, it is important to observe the inside of the abdominal cavity using a laparoscope.