囊胞空腸吻合術後の膵囊胞性疾患に対し腹腔鏡下膵体尾部切除術を施行した1例

A case of laparoscopic distal pancreatectomy for cystic pancreatic tumor after cystojejunostomy

◆要旨：患者は30歳代，女性．飲酒歴のある高度肥満患者．前医で膵囊胞性病変に対し術中囊胞内容液中アミラーゼ値が高値であったことから仮性囊胞と診断され，開腹下囊胞空腸吻合術を施行された．3年後に心窩部痛再燃と囊胞再増大を認め当科紹介となった．画像所見より膵粘液性囊胞腫瘍（mucinous cystic neoplasm of the pancreas；以下，MCN）と診断し，囊胞に吻合された空腸断端から剝離を行い，安全に腹腔鏡下膵体尾部切除術を施行しえた．最終病理診断はMCN, low grade dysplasiaであった．囊胞内容液中アミラーゼ高値のMCNが存在し仮性囊胞との鑑別を要する点，また，囊胞消化管吻合後でさらに高度肥満患者でも手術手技の工夫で腹腔鏡下手術が安全に実施可能であった点で示唆に富むと思われ報告する．

We herein present a 30-year-old obese female diagnosed as having mucinous cystic neoplasm of the pancreas （MCN）. The tumor had been treated by open cystojejunostomy at another hospital under a provisional diagnosis of pancreatic pseudocyst due to high amylase level of the fluid content collected from the tumor during the operation. Three years after the operation, abdominal pain recurred and enlargement of the cystic lesions was noted. The patient was then referred to our hospital for further treatment. Preoperative diagnosis was MCN and laparoscopic distal pancreatectomy with combined resection of cystojejunostomy was performed. Pathological examination of the resected specimen revealed MCN with low grade dysplasia. This case suggests that MCN should not be excluded even when the cyst fluid amylase levels is high, and laparoscopic surgery can be safely performed by adequate surgical techniques even for obese patient with a history of laparotomy.