腸間膜デスモイド型線維腫症に対し腹腔鏡下に摘出しえた1例

A case of mesenteric desmoid-type fibromatosis treated by laparoscopic tumor extirpation

◆要旨：症例は70歳，男性．C型慢性肝炎治療後の定期CT検査で下腹部正中に4cm大の腫瘍を指摘された．腸間膜由来の腫瘍を疑い，診断的治療として腹腔鏡下に手術を施行した．腫瘍は腸間膜血管に強固に癒着しており浸潤が疑われたが，腸管合併切除を行わずに腫瘍を摘出し，デスモイド型線維腫症の病理診断を得た．腹腔内デスモイド型線維腫症は非常に稀な腫瘍で標準治療は確立されていない．局所浸潤傾向が強いため，しばしば開腹下に他臓器合併切除を伴う広範切除が行われてきたが，近年では腹腔鏡手術や非手術療法の有効性も報告されている．腹腔内デスモイド型線維腫症の治療戦略について文献的考察を加えて報告する．

　A 70-year-old man was found to have a 4-cm neoplastic lesion in the lower mid abdomen by routine computed tomography （CT） for chronic hepatitis C. The tumor appeared to have originated from the mesentery; however, imaging examinations, including CT and magnetic resonance imaging, did not result in a definitive diagnosis. Diagnostic laparoscopic surgery was therefore performed. Despite the tumor being strongly adherent to the mesenteric vessels, it was successfully excised without resection of the intestine. The tumor was pathologically diagnosed as desmoid-type fibromatosis （a desmoid）. Intra-abdominal desmoids are extremely rare and there is no consensus on their optimal treatment. Because they are locally invasive, complete resection can often be achieved only by open surgery with resection of other organs. However, the effectiveness of laparoscopic surgery and non-surgical treatments has also been demonstrated in recent years. We here report laparoscopic resection of a mesenteric desmoid and discuss the treatment strategy for intra-abdominal desmoids.