腹腔鏡下脾部分切除術を施行し正常脾を温存した大型脾囊胞の1例

A case of laparoscopic partial splenectomy for large splenic cyst

◆要旨：患者は30代，女性．心窩部痛を主訴に近医を受診し，CTで直径8cm大の脾囊胞を指摘され，当科紹介となった．良性囊胞と考えられたが腫瘍径が大きく有症状であり手術適応と考えられた．若年女性であることから正常脾を温存する方針とした．腹腔鏡下に脾動静脈本幹・上下極枝をそれぞれ確保し，脾動静脈上極枝のみを切離して虚血域に囊胞が含まれることを確認したのちに脾実質を切離し，脾上極を摘出した．術後は合併症なく退院となった．病理組織学的検査では上皮性囊胞の診断であった．脾囊胞に対する腹腔鏡下脾部分切除術は根治性・低侵襲性に優れ，安全性に考慮したうえで実施可能な有用な術式であると思われた．

　A woman in her thirties, suffering from mild epigastralgia, was admitted to the nearby hospital. Abdominal CT showed an 8cm diameter cyst confined to the upper pole of the spleen, and the patient was referred to our department for treatment. Although the cyst was considered to be benign, surgery was indicated because of large size and symptoms caused by the cyst. Laparoscopic partial splenectomy was performed, preserving the normal spleen, because the cyst was suspected to be benign and the patient was a young woman. The main trunk of the splenic vessels, upper and lower pole branches were secured laparoscopically. The upper pole branch of the splenic vessels was cut off, confirming that the cyst was within the ischemic area, and then the upper pole of the spleen was resected. Postoperative course was uneventful and the patient was discharged on the 7th postoperative day. Pathological examination revealed a diagnosis of epithelial cysts. Laparoscopic partial splenectomy for splenic cysts may be a safe procedure with good cosmetic outcome.