十二指腸NETに対して内視鏡併用腹腔鏡下十二指腸部分切除術を施行した1例

A case of neuroendocrine tumor in duodenal bulb resected by laparoscopy endoscopy cooperative surgery

◆要旨：患者は77歳，女性．検診の胃透視で異常を指摘され当院を受診した．上部消化管内視鏡検査で十二指腸球部に径4mmの粘膜下腫瘍を認め，生検を施行されNET G1と診断された．内視鏡的切除を試みたが困難であったため手術の方針とした．腫瘍径が小さく漿膜側から正確に切離ラインを決めることが困難なことが想定されたため，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を選択した．術後経過は問題なく第7病日に退院となった．十二指腸NETについて確立した術式はないが本術式は低侵襲であり，また本症例のような径の小さい腫瘍でも確実かつ必要十分に切除でき，今後有効な治療選択肢になりうると考えられたため報告する．

A 77-year-old woman was admitted to our hospital due to abnormality of barium examination. Upper endoscopy revealed that submucosal tumor was located in the anterior wall of duodenal bulb. Histologic diagnosis was neuroendocrine tumor（NET G1）. Initially, we tried to perform endoscopic submucosal resection of the lesion. But this technic was difficult because of non-lifting of the lesion after submucosal injection. Thus, we tried surgical resection of the tumor. It is difficult to recognize the border of the lesion from outside the duodenum and to remove it locally. We considered that laparoscopy-endoscopy cooperative surgery（LECS） was the best treatment for the resection of this tumor to avoid excessive resection of the duodenal wall. We located the NET by endoscopy and mucous layer was cut around the tumor. The tumor was resected manually with ultrasonic coagulating shears and the defect on the duodenal wall was repaired with manual running suture under laparoscopic surgery. The patient was discharged on 7 postoperative day without any eventful postoperative course. LECS is feasible for the treatment of duodenal NET. We report our experience of successful laparoscopic surgery for duodenal NET.