完全内臓逆位に対し低侵襲膵頭十二指腸切除術を行った1例

Minimally invasive pancreatoduodenectomy in a patient with situs inversus totalis : A case report

◆要旨：症例は65歳の男性．近医で完全内臓逆位を伴う主膵管型膵管内乳頭粘液性腫瘍と診断され，経過観察となっていた．初診から4年後，造影CT検査で膵頭部主膵管内に14mmの結節病変を認めたため，当科へ紹介され受診となった．精査の結果，切除適応のある病変と診断し，低侵襲膵頭十二指腸切除術を行った．切除までの操作を腹腔鏡下に行い，再建操作をロボット支援下に行ったが，胆道や血管の走向破格もなく，正位の患者と同様のポート位置と手順で行うことができた．術後合併症はなく経過し，術後10日目に退院した．完全内臓逆位に対するロボット支援を伴う低侵襲膵頭十二指腸切除術の報告例はなく，文献的考察を加えて報告する．

　The patient was a 65-year-old male. He was diagnosed with main duct type intraductal papillary mucinous neoplasm（IPMN）without malignant finding and situs inversus totalis, and subsequently underwent surveillance every 6 months. Four years later, enhanced computed tomography revealed a nodular lesion, 14mm in diameter in the main pancreatic duct in the head of the pancreas. The patient underwent minimally invasive pancreaticoduodenectomy（MIPD）consisting of laparoscopic resection and subsequent robotic reconstruction. There was no pancreatobiliary anomaly, and the operation could be completed using regular port sites and surgical procedures, like in normal anatomy. The histopathological diagnosis was low grade dysplasia of intraductal papillary mucinous neoplasm. The postoperative course was uneventful, and the patient was discharged on the 10 days after the operation.