胆囊摘出術のポートを利用して腹腔鏡下に胆囊と同時切除を行った小腸間膜原発孤立性線維性腫瘍の1例

Simultaneous laparoscopic resection of the gallbladder and a solitary fibrous tumor of the small intestinal mesentery using laparoscopic cholecystectomy ports : A case report

◆要旨：症例は71歳，女性．胆石症に対する術前精査の腹部造影CT検査にて，腹腔内に60mm大の境界明瞭で内部不均一な腫瘍を偶発的に認めた．腫瘍は小腸壁に近接していたが主座は腸間膜内と考えられ，診断的治療として胆囊と同時に切除する方針とした．まずは4孔式腹腔鏡下手術にて胆囊を摘出後，腹腔鏡下に下腹部を観察すると，小腸間膜内に表面赤色調の腫瘍を認めた．胆囊摘出術のポートを利用し腫瘍を臍下まで誘導し，体外にて腫瘍を含むように小腸部分切除を実施した．術後病理検査では免疫組織化学染色にてSTAT6陽性であり，最終的に小腸間膜原発の孤立性線維性腫瘍と診断した．小径の状態で発見されたため腹腔鏡下手術にて胆囊と同時切除が可能であった．

　The patient was a 71-year-old female. Preoperative contrast-enhanced computed tomography of the abdomen for cholelithiasis incidentally revealed a well-defined, internally heterogeneous tumor of 60mm in size. The tumor was close to the wall of the small intestine ; however, its main location was in the mesentery. The decision was made to simultaneously resect the mesenteric tumor and gallbladder via laparoscopic surgery. The gallbladder was initially removed, followed by observation of the lower abdomen which revealed a tumor with a reddish surface in the mesentery of the small intestine. The tumor was moved to below the umbilicus using laparoscopic cholecystectomy ports, and a partial resection of the small intestine was performed outside the abdomen. Postoperative pathological examination showed STAT6 positivity on immunostaining, and the final diagnosis was a solitary fibrous tumor of the small intestinal mesentery. Because the tumor was small in diameter, simultaneous resection of the gallbladder by laparoscopic surgery was possible.