増大傾向を認めた無症候性膵動静脈奇形に対して腹腔鏡下膵体尾部切除術を施行した1例

Laparoscopic distal pancreatectomy for asymptomatic slowly growing pancreatic arteriovenous malformation

◆要旨：患者は49歳，男性．近医より腹直筋血腫を指摘され，治療目的で当院を紹介受診した．精査の腹部造影CT検査で偶発的に，膵体尾部に長径50mm大の腫瘤を認めた．動脈相では腫瘤内に網状濃染と門脈の早期描出の所見を認め，膵動静脈奇形と診断した．他疾患のため4年前に施行されていたCT検査では，膵尾部に25mm大の同様の所見を認めた．無症状であったが，腫瘤の増大と膵体部への進展を認めたため手術適応と判断した．術前に脾動脈に対して経カテーテル動脈塞栓術を施行し，腹腔鏡下膵体尾部切除術を行った．膵実質表面や後腹膜に新生血管を認め出血に注意を要したが，腹腔鏡下で安全に完遂しえた．

　A 49-year-old man was diagnosed with hematoma of the rectus abdominis muscle and referred to our hospital for further evaluation. Computed tomography （CT） accidentally showed a 50-mm mass in the body and tail of the pancreas. Contrast-enhanced CT showed racemose vascular networks in the pancreatic tail and early filling of the portal vein during the arterial phase. Pancreatic arteriovenous malformation （PAVM） was diagnosed. The 25-mm mass with the same findings was detected on CT 4 years ago. The PAVM had become larger, and the need for intervention was considered. Preoperative transcatheter arterial embolization of the splenic artery was performed, followed by laparoscopic distal pancreatectomy for PAVM. Since the neovascularity around the pancreas and retroperitoneum was predisposed to intraoperative bleeding, we have to be careful about intraoperative massive bleeding to safely perform laparoscopic surgery.