Vater乳頭近傍の神経内分泌腫瘍に対して腹腔鏡下十二指腸部分切除を行った1例

Duodenal neuroendocrine tumor in the neighborhood of Vater papilla resected by laparoscopic surgery

◆要旨：患者は65歳，男性．十二指腸Vater乳頭近傍の神経内分泌腫瘍（neuroendocrine tumor ：NET）を指摘され当院紹介となった．当院で施行した上部消化管内視鏡検査ではVater乳頭の同心円状の十二指腸後壁に生検瘢痕を認め病変部位と診断した．腹腔鏡・内視鏡合同手術（laparoscopy-endoscopy cooperative surgery：LECS）による十二指腸部分切除が最も適切と考え選択した．内視鏡により腫瘍位置を同定したうえで，前壁を切開し開放した．腫瘍とVater乳頭の位置を直接確認し，電気メスで腫瘍部分の全層切除を行った．患者は順調に経過し術後14日目に退院となった．LECSによる治療は，Vater乳頭近傍のNETに対する有効な治療選択肢になりうると考えられたので報告する．

A 65-year-old man was referred to our hospital because of duodenal neuroendocrine tumor（NET） near Vater papilla. Esophagogastroduodenoscopy（EGD） confirmed the biopsy scar at the posterior wall of the duodenum, the same level as Vater papilla. We considered that laparoscopy-endoscopy cooperative surgery（LECS） was the best treatment for the resection of this tumor. First, we located the NET by endscope and dissected the anterior wall of the duodenum. Because the location of NET and Vater papilla were confirmed directly by laparoscope, we were able to resect all layers of NET precisely by electrical scalpel. The patient was discharged on 14 postoperative day after uneventful postoperative course. LECS is feasible for the treatment of duodenal NET near Vater papilla. We report our experience of successful laparoscopic surgery for duodenal NET.