体腔内吻合を用いた完全腹腔鏡下手術が有用であった虫垂粘液囊胞腺癌の1例

Laparoscopic surgery with intracorporeal anastomosis for mucinous cystadenocarcinoma of the appendix : A case report

◆要旨：患者は88歳，女性．主訴は右下腹部痛．腹部造影CTで虫垂根部の囊胞性腫瘤が上行結腸内へ陥入し腸重積をきたしていた．虫垂粘液囊胞による腸重積の診断で下部消化管内視鏡を施行した．送気により腸重積は解除され，盲腸に粘膜下腫瘤様所見を認めた．虫垂粘液囊胞腺癌の可能性を念頭に，手術は破裂や播種に留意し，完全腹腔鏡下回盲部切除術，体腔内吻合で施行した．体腔内吻合で行うことで剝離を最小限に留め，腸管挙上は行わないことで破裂のリスクを少なくした．また腹腔内で検体を切除できるため切除検体を回収袋に入れ摘出することで播種予防にも配慮した．術後8日目で退院した．mucinous adenocarcinoma，pT3, pN0, StageⅡの診断であった．17か月で無再発生存中である．

　We report a case of mucinous cystadenocarcinoma of the appendix with intussusception, which was treated by laparoscopic surgery with intracorporeal anastomosis. An 88-year-old woman presented with lower right quadrant pain. Computed tomography revealed intussusception in the ascending colon induced by a cystic tumor of the appendix root. Colonoscopy was performed under the diagnosis of intussusception by mucinous cyst of the appendix. Intussusception was easily reduced by colonoscopy and a submucosal tumor-like mass was observed in the cecum. Because of the possibility of mucinous cystadenocarcinoma of the appendix, laparoscopic ileocecal resection with intracorporeal anastomosis was performed cautiously. During intracorporeal anastomosis, the peeling operation was minimized and the procedure to lift the intestinal tract was not performed, thereby reducing the risk of cystic rupture. To prevent dissemination, the resected ascending colon and ileum including the tumor were placed in the retrieval bag and removed. The patient was discharged from our hospital 8 days after surgery. Histopathological examination confirmed a mucinous cystadenocarcinoma of the appendix （T3, N0, StageⅡ）. The patient is alive without recurrence 17 months after surgery.