腹腔鏡下経腹経仙骨的切除を施行したtailgut cystの1例

Laparoscopic transabdominal and transsacral approach to tailgut cyst

◆要旨：患者は64歳，男性．PSA高値の精査中に仙骨前面腫瘍を指摘された．CT，MRI検査で第2〜5仙椎レベルにまたがる34mm大の囊胞性腫瘍であった．手術は腹腔鏡下に直腸後壁と囊胞の剥離を先行し，経仙骨的切除を併用して根治切除を行うことが可能であった．術後合併症なく退院した．病理診断はtailgut cystで悪性所見は認めなかった．仙骨前面腫瘍は稀な疾患であるが術前診断が困難なことが多く，悪性の可能性もあるため外科的切除が第一選択となる．切除は経仙骨的アプローチが一般的だが，腹腔鏡アプローチを併用することで，腫瘍頭側の剝離が安全かつ確実に施行可能となり，狭い骨盤内での拡大視効果とあいまって有効な術式と考えられた．

The patient was a 64-year-old man who had a family history that his daughter had surgical treatment of tailgut cyst. A pelvic CT scan which was done for the purpose of screening of PSA elevation revealed a presacral tumor. The size of this cystic tumor was 34mm with solid part and was located in S2-5 levels. Laparoscopic transabdominal and transsacral approach surgery was performed. Postoperative course was uneventful. This tumor was diagnosed as a tailgut cyst by pathological findings and involved no malignancy. Tailgut cyst has malignant potential in 2-13％. The treatment of a presacral tumor should be complete surgical removal. The combined approach of transabdominal and transsacral approach with laparoscopy was useful because it provided good overview in pelvic, which is important for complete resection and preserving pelvic nerval structures.