脾破裂をきたした悪性リンパ腫に対して用手補助腹腔鏡下脾臓摘出術を施行した1例

A case of ruptured malignant lymphoma of the spleen treated with hand-assisted laparoscopic splenectomy

◆要旨：症例は66歳，男性．脾腫瘍と腹腔内リンパ節腫大を指摘された．腋窩リンパ節生検でびまん性大細胞性B細胞リンパ腫と診断され，EPOCH療法を開始した．治療開始6日後に突然の左上腹部痛とともに血圧低下をきたし，ショック状態となった．造影CT検査で脾腫瘍破裂による腹腔内出血と診断され，緊急で用手補助腹腔鏡下脾臓摘出術を施行した．術後合併症なく術後11日目に自宅退院となり，術後12か月無再発生存中である．悪性リンパ腫による脾破裂は稀な病態であり，過去の報告では開腹脾臓摘出術が多く報告されているが，全身状態によっては用手補助腹腔鏡下脾臓摘出術も有用な選択肢になると考えられた．

　The patient was a 66-year- old man, who had a diagnosis of diffuse large B-cell lymphoma following axillary lymph node biopsy. Six days after the start of chemotherapy, he experienced upper abdominal pain and low blood pressure. Enhanced abdominal computed tomography revealed splenic rupture and extravasation in his spleen, and fluid collection with high density around the liver and the spleen. Under the diagnosis of non-traumatic splenic rupture due to malignant lymphoma, an emergency operation, a hand-assisted laparoscopic splenectomy, was performed. The patient was discharged on postoperative day 11 with no postoperative complications. A total of six courses of EPOCH therapy were given, and no evidence of recrudescence of malignant lymphoma was evident at 12 months postoperatively. We reported a rare case of splenic rupture due to malignant lymphoma where hand-assisted laparoscopic splenectomy was an effective treatment option for treatment.