上行結腸脂肪腫に対して腹腔鏡・内視鏡合同手術を施行した1例

A case of ascending colonic lipoma resected by laparoscopy endoscopy cooperative surgery

◆要旨：腹腔鏡・内視鏡合同手術（laparoscopy endoscopy cooperative surgery：LECS）は腹腔鏡と内視鏡を併用し，粘膜下腫瘍の過不足ない切除を行う手技である．今回筆者らは上行結腸脂肪腫に対して，LECSによる上行結腸楔状切除術を施行したので報告する．患者は71歳，女性，主訴は下血．下部消化管内視鏡検査で上行結腸に約40mmの粘膜下腫瘍を認め，CT検査で上行結腸脂肪腫が疑われた．手術は内視鏡で腫瘍を確認し一部全層切開し，腹腔鏡下に超音波凝固切開装置で全周性に切離し腫瘍を切除した．バッグに回収し経肛門的に摘出し，腸壁欠損部は自動縫合器で閉鎖した．術後経過良好で9日目に退院した．病理診断は成熟脂肪腫であった．本術式は小開腹が不要で低侵襲かつ整容性の優れた術式と考えられた．

Laparoscopy endoscopy cooperative surgery（LECS） is a procedure to adequately resect a submucosal tumor using laparoscopic and endoscopic techniques. This time we report a case of ascending colonic wedge resection by LECS for ascending colonic lipoma. The patient was 71-year-old female with a chief complaint of melena. We performed colonoscopy and found a submucosal tumor of about 40 mm in the ascending colon. Ascending colonic lipoma was suspected in CT examination. At the time of surgery, we confirmed the tumor with an endoscope and incised all layers of the colonic wall. Then, the entire circumference of the lesion was dissected with an ultrasonically activated device to resect the tumor. We placed the tumor in a bag and removed it through the anus. The defect of the colon wall was closed with an automatic suturing device. As the post-operative course was satisfactory, the patient was discharged from the hospital on Day 9. The pathological diagnosis was mature lipoma. This procedure did not require a small incision, suggesting that it could be a minimally invasive and cosmetically satisfactory operation.