下行結腸粘膜下腫瘍に対し腹腔鏡下漿膜筋層切開法にて腫瘍切除を行った1例

A case of descending colon submucosal tumor treated by laparoscopic serosal and muscular layers incision technique

◆要旨：患者は66歳，女性．便潜血陽性にて下部消化管内視鏡を施行したところ，下行結腸に長径2cmの粘膜下腫瘍が発見され，患者が切除を希望したため外科治療目的で当院に紹介された．超音波内視鏡検査にて固有筋層由来の粘膜下腫瘍と診断され，腫瘍が腸間膜対側に局在していたため，腹腔鏡下に漿膜筋層切開法（serosal and muscular layers incision technique；以下，SAMIT）による腫瘍切除術を行った．術後経過良好で，第6病日で退院となった．病理結果は神経鞘腫で，切除断端は陰性であった．大腸粘膜下腫瘍に対するSAMITによる手術例は本報告が第1例目と思われる．

　This case report describes a 66-year-old female patient who underwent a colonoscopy because of a positive fecal occult blood test. The result showed a descending colon submucosal tumor with a diameter of 2 cm. She was referred to our hospital for surgical treatment. Because the tumor was found to originate from the muscularis propria and was localized on the antimesenteric side, the laparoscopic serosal and muscular layers incision technique （SAMIT） was used to execute full-thickness resection of the tumor. The postoperative course was uneventful, and the patient was discharged on postoperative day 6. The histopathological examination revealed that the tumor was schwannoma and the surgical margin was negative. To the best of our knowledge, this report is considered to be the first case of surgery using SAMIT for colorectal submucosal tumors.