腹腔鏡下に切除し得た骨盤内坐骨神経鞘腫の1例

A case of pelvic sciatic Schwannoma resected laparoscopically

◆要旨：症例は34歳の女性で，腹痛精査の画像検査で骨盤内左Alcock管頭側に4.5cm大の囊胞性腫瘤を指摘された．坐骨神経鞘腫が疑われ，悪性の可能性を否定できないことから切除の方針となった．患者は挙児希望があり可能な限り低侵襲手術が望ましいと判断して，腹腔鏡下での切除を行った．手術は5ポートで内外腸骨血管の間で後腹膜を剝離し，骨盤内臓器と坐骨神経を温存して核出術を行った．組織はS-100蛋白陽性，悪性所見はなく良性の神経鞘腫と診断した．患者は術後5日で軽快退院し，神経障害は術後3か月で消失，術後12か月で再発なく今後の妊娠を計画している．本術式は適応を選べば低侵襲で安全に施行可能と思われ，文献的考察を加えて報告する．

　A 34-year-old woman was diagnosed with a 4.5-cm cystic mass on the left side of the head of Alcock's canal in the pelvis during imaging examination for abdominal pain. A sciatic schwannoma was suspected, and since the possibility of malignancy could not be ruled out,surgical resection was considered. Since the patient wished to have a baby, we decided that minimally invasive laparoscopic surgery was preferable. We performed laparoscopic enucleation by dissecting the retroperitoneum between the internal and external iliac vessels and preserving the pelvic organs and sciatic nerve. Histopathological finding showed that the tissue was positive for S-100 protein and there were no malignant findings; the diagnosis of benign schwannoma was made. The patient was discharged from the hospital 5 days after the operation, and the neurological disorder disappeared 3 months after the operation. There is no recurrence 12 months after the operation, and the patient is planning a future pregnancy. We believe that this procedure can be performed safely and less invasively under appropriate surgical indications.