腹腔鏡・経仙骨アプローチを併用して摘出した仙骨前巨大類表皮囊腫の1例

A case of presacrum giant epidermoid cyst resected by combined transabdominal/sacral approach using laparoscopic procedure

◆要旨：患者は59歳，女性．殿部腫瘤と排便困難を1年半前から自覚していた．仙骨前面から殿部にかけて径18cmの腫瘤を認め，仙骨前囊胞性腫瘍と診断して手術を施行した．経腹・経仙骨の双方向からのアプローチで，腹腔内操作は腹腔鏡を使用し直腸背側と仙骨前面からの腫瘍剝離を骨盤底まで施行した．その後経仙骨的に殿部皮下と尾骨を剝離し腫瘍を一括切除した．組織は類表皮囊腫で悪性所見は認めなかった．術後1年現在再発は認めていない．仙骨前類表皮囊腫は本邦で100例が報告され，時に悪性化する稀な疾患である．完全切除が基本であるが標準術式は定まっていない．腹腔鏡を併用することでサイズの大きい仙骨前腫瘍に対し低侵襲で安全性が高い手術を行うことができた．

A 59 years old woman noticed a gluteal mass and dyschezia for one and a half years. An 18cm mass was detected from the presacral space to the buttocks and a diagnosis of presacral cyst-related tumor was made. Laparoscopic surgery was performed, using 2 directions approach（combined transabdominal and transsacral）. We ablated the tumor from rectum dorsum and sacral surface, and exposed the pelvic floor by transabdominal laparoscopic approach. Subsequently, after having ablated the tumor from gluteal subcutis and coccyx by transsacral approach, the tumor was excised en-block. Histological diagnosis was epidermoid cyst, and there was no malignancy. No recurrence has been detected, one year after the surgery. Hundred cases of presacral epidermoid cyst have been reported in Japan, and poor prognosis is observed in some rare cases. As for the treatment, complete resection is recommended, but there is no standard operative method. By using laparoscope, we were able to perform not only less invasive but also safe operation for the resection of large size presacral tumor.