遺伝性出血性末梢血管拡張症（Rendu-Osler-Weber病）を併存した胆囊ポリープに対して腹腔鏡下胆囊摘出術を行い早期胆囊癌と判明した1例

A case of gallbladder polyp with hereditary hemorrhagic telangiectasia diagnosed as early stage gallbladder cancer after laparoscopic cholecystectomy

◆要旨：症例は60代，女性で，近医での経過観察中に胆囊ポリープが増大傾向にあり，悪性の可能性も否定できないため当科を紹介受診した．当科受診時に白血球数が低値であったため，血液内科を受診し，反復性鼻出血や舌・硬口蓋の毛細血管拡張などの身体所見に加え，胸腹部CT検査で肝肺の動静脈瘻を認めたことから，遺伝性出血性末梢血管拡張症（Rendu-Osler-Weber病：以下，Osler病）と診断した．Osler病を合併することによる大量出血を回避するために，術前に綿密な手術戦略を立てたうえで，慎重・丁寧な手術操作を行うことで腹腔鏡下胆囊摘出術を施行した．病理診断で胆囊癌〔pT1a（M）〕と診断した．Osler病患者に対して腹腔鏡下胆囊摘出術を行った報告例は他になく，極めて稀な症例を経験したので報告する．

　The patient was 60s year-old woman. She came to our department for a thorough examination of a gallbladder polyp that showed an increasing tendency to suspect malignancy during follow-up with her family doctor. She had recurrent epistaxis, telangiectasia of the tongue and hard palate and arteriovenous fistula in liver and lung, which lead to the diagnosis of Rendu-Osler-Weber disease（Osler's disease）. She underwent a laparoscopic cholecystectomy with meticulous surgical strategy and careful intraoperative manipulation, to avoid excessive bleeding due to complication with Osler's disease. Pathological examination after resection showed accidental gallbladder cancer（Gb, pT1a（M））in a gallbladder polyp. This is the first case report of laparoscopic cholecystectomy in a patient with Osler's disease, and we report our experience with this extremely rare case.