腹腔鏡補助下に切除した空腸起始部原発性小腸癌の1例

A case of small intestinal cancer located at the duodenojejunal junction treated by laparoscopically assisted surgery

◆要旨：患者は48歳，男性．3か月前から腹部膨満，嘔吐を繰り返していた．腹部膨満と嘔吐を主訴に外来受診した．来院時心窩部に圧痛を認め，腹部造影CT検査にて空腸起始部の腫瘍性病変および胃から十二指腸の著明な拡張を認めた．内視鏡下生検にて腺癌と診断し，減圧後に手術を行った．手術所見では，空腸起始部に腫瘍を認め，腹腔鏡下に十二指腸を下大静脈前面まで十分に剝離，脱転し，小開腹下に十二指腸空腸部分切除，リンパ節郭清，十二指腸空腸吻合を行った．術後経過は良好で，術後12日目に退院した．病理検査では中分化腺癌（UICC Stage ⅡA）の診断であった．空腸起始部小腸癌の切除手術に腹腔鏡補助下手術の選択が有用であった．

A 48-year-old man with continuous abdominal pain and vomiting for three months was admitted to our hospital. An abdominal enhanced computed tomography showed a solid obstructive intestinal tumor located at the duodenojejunal junction with severe dilation of the duodenum. With the preoperative endoscopic diagnosis of small intestinal adenocarcinoma, following decompression with nasogastric tube, laparoscopic assisted surgery was performed. The duodenum was fully mobilized with laparoscopic procedure to the level of the inferior vena cava, and tumor resection with lymph node dissection was performed under mini-laparotomy. Duodenojejunostomy was performed with functional end to end anastomosis. The postoperative course was uneventful and he was discharged on the 12th postoperative day. The histopathological diagnosis of the tumor was moderate differentiated adenocarcinoma of the jejunum （UICC Stage IIA）. Laparoscopic assisted surgery was an effective approach for the treatment of the small intestinal cancer located at the duodenojejunal junction.