腹腔鏡補助下経腹・仙骨式アプローチにより切除した前仙骨部類表皮腫の1例

A case of presacral epidermoid cyst resected by a laparoscopically assisted abdominosacral approach

◆要旨：患者は65歳，女性．会社の検診の腹部超音波検査にて卵巣囊腫が疑われ，当院婦人科を受診し，その際に施行された腹部CTで,骨盤内腫瘍を指摘され当科紹介受診となった．腹部造影CTで前仙骨部に80mm大の囊胞性腫瘤を認め，腫瘤はS3の高さから括約筋を貫き尾骨に接して存在していた．尾骨の合併切除および骨盤深部剝離操作が必要と考えられたことから，腹腔鏡を用いた経腹・仙骨式アプローチによる前仙骨腫瘤切除術を行った．病理組織学的には，類表皮腫であった．前仙骨部類表皮腫の本邦報告例では，腹腔鏡を用いた経腹式アプローチに加え，仙骨式アプローチを併用した報告例はなく，視認性・操作性・安全性の観点からも有用であったため報告する．

A 65-year-old woman was suspected of having an ovarian cyst by abdominal ultrasonography at medical checkup offered by her employer. She received further examination at the department of gynecology at our hospital. Because pelvic tumor was indicated in abdominal CT, she was referred to our department. In abdominal contrast CT, a cystic tumor of 80 mm was confirmed in the presacral region. The tumor was located in the region from the height of S3 to the coccyx through the levator ani muscle. Since combined resection of the coccyx and the removal of the deep part of pelvis were considered to be necessary, presacral tumor resection by laparoscopic abdominosacral approach was performed. Histopathologically, the tumor was an epidermoid cyst. There is no previous case report of presacral epidermoid cysts resected by combination of transsacral and transabdominal approaches using a laparoscope in Japan. We report this case since the abdominosacral approach was useful in terms of visibility, operability, and safety.