腹腔鏡下切除術を施行した後腹膜原発Müller管囊胞の1例

A case of retroperitoneal Müllerian cyst resected by laparoscopic procedure

◆要旨：患者は43歳，女性．3年前に腹腔内に囊胞性病変を指摘され，最近になり腹部膨満を自覚し，近医で囊胞性病変の増大を認めたため加療目的に当科紹介となった．腹部CTおよびMRI検査で22×16×35cmの巨大後腹膜囊胞であったが，囊胞内結節や他臓器浸潤を疑う所見を認めなかったため腹腔鏡下切除術を施行した．術中に囊胞穿刺による内容液吸引と穿刺口結紮を行い内容液の腹腔内散布なく囊胞の虚脱を図り切除を行った．病理組織学的検査でMüller管囊胞の診断で，悪性所見は認めなかった．悪性疾患の可能性が低い巨大後腹膜囊胞に対しては，囊胞の大きさにかかわらず適切な方法で囊胞虚脱を図ることで腹腔鏡下切除術が可能であると考えられる．

　A 43 year-old woman was diagnosed with an abdominal cystic mass three years previously. She was referred to our hospital due to complaints of abdominal distension and the enlargement of the cystic mass. The abdominal CT and MRI revealed a 22×16×35 cm very large retroperitoneal serous cystic mass; however, there were no nodular formations or adjacent organ invasion. Therefore, we performed a laparoscopic resection, in which we employed intraoperative puncture and suction of the cystic contents, and ligation of the puncture hole, without abdominal dissemination. The histopathological examination revealed a definitive diagnosis of a very large retroperitoneal Müllerian cyst, with no malignancy. Overall, the intraoperative suction of cystic contents without abdominal dissemination can be a reasonable technique when conducting laparoscopic procedures for patients with retroperitoneal cysts with no malignant potential.